The topic of medication adherence can be a challenging one. Patients think they are more adherent than they actually are, and doctors suspect they are not, but have limited time to intervene and even less insight into what really goes on between visits.

Given that “good” adherence is typically considered to be less than 80% of days with the drug in the patient’s possession (Proportion of Days Covered – PDC)(1), the World Health Organisation’s (WHO) reported a global average of 50% means that there is massive room for improvement. In fact, adherence rates of 50% are regarded as “very poor” and are associated with an increased risk of poor disease outcomes (2,3,4,5,6).

Until now, a realistic way to improve adherence rates has been out of reach for healthcare providers. Most GPs see their chronic patients less than twice a year, which means their ability to influence health-related behaviour is minimal.

An ideal solution would:

• increase the number of times the doctor sees chronic patients;
• facilitate more relevant clinical discussion by giving providers insights into how adherent their patients are in-between visits;
• enable providers to make decisions that allow their patients to receive adherence management and support;
• ensure that patient behaviour will be monitored after visiting the practice and that information will be brokered back to the provider when the patient visits again.

The newly released features within the GoodX practice management software deliver precisely that. GoodX has partnered with Health Window (a company specialising in managing chronic medication adherence) to deliver a solution that will facilitate improved coordination of care between your practice and pharmacy. The solution leverages Health Window’s close relationships with its pharmacy partners and the intelligent use of data.

Health Window combines data-driven interactions with the power of human-to-human connection to improve chronic dispenses and continuity of care through call centre interventions (Patient Ready Parcel – PRP). In addition, patients who cannot be reached through the call centre receive electronic interventions that improve adherence (Pack My Meds – PMM). The image below shows the difference between the average number of chronic dispenses per year for patients receiving the various interventions. 

In an ideal world, Health Window would offer its services to all chronic patients. Unfortunately, the costs of the interventions limit the number of patients that can receive calls and digital messages. The ability to target specific patients depends on funding from their pharmacy and pharmaceutical partners. Certain pharmaceutical companies invest in adherence management for their brands, making them partners in the move towards improved disease outcomes.

When patients use a product that has adherence funding, they are more likely to receive Health Window services and stay on therapy. Conversely, those not using products funded by pharma are unlikely to receive adherence management services and have an increased risk of being non-adherent to therapy.

The benefits of adherence management go beyond monthly script fills. Patients who receive adherence management are more likely to visit their doctor for a repeat script and clinical assessment. The figure below shows the average number of doctor visits per year for the various patient groups and the revenue lost as a result of missed visits. The revenue was calculated using a consultation fee of R500. 

GoodX Software, through collaboration with Health Window, aims to provide more information by displaying the average adherence rates per product on the scripting platform.

Adherence indicators are displayed next to each scripted product, as shown below:

Hovering over the indicator for each drug will show the average adherence for that molecule and whether the product has funding for call centre interventions or digital interventions. Alternative products will be displayed, with the option to switch to one with better adherence rates. Having more patients managed by Health Window will increase patient volumes in the practice. Furthermore, being better informed can result in better clinical decision making and, ultimately, improved outcomes. By choosing products that have invested in adherence, you are giving your patients the best chance of staying on therapy and achieving improved disease control.

In addition to this, Health Window will be monitoring the practice’s patients within their pharmacy network for script expiry and, through integration with the GoodX online calendar, make bookings for patients on the practice’s diary for check-ups and script renewals. This will increase the number of patients returning to the practice.

Continuation of this service depends on Health Window’s access to the dispensing behaviour of patients. When a patient hands in their script at a Health Window affiliated pharmacy, Health Window can track and manage their adherence monthly and direct them back to the practice when the repeat script is due. However, should a patient move out of Health Window’s pharmacy network, this will not be possible, thereby increasing the likelihood of non-adherence and disappearance from your practice.

Navigate to Health Window’s website for more information about them. 

References

1. Is there a Threshold for Medication Adherence? Lessons Learnt From Electronic Monitoring of Drug Adherence Michel Burnier*Front. Pharmacol., 09 January 2019 https://doi.org/10.3389/fphar.2018.01540
2. Non-adherence to cardiovascular medications Kumaran Kolandaivelu, Deepak L. Bhatt G.et al. European Heart Journal, Volume 35, Issue 46, 7 December 2014, Pages 3267–3276, 
3. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes L.A. DONNELLY1, A.D. MORRIS2 and J.M.M. EVANS, QJM Advance Access published May 15, 2007
4. Kim S, Shin DW, Yun JM, Hwang Y, Park SK, Ko YJ, Cho B. Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications. Hypertension. 2016 Mar;67(3):506-12. doi: 10.1161/HYPERTENSIONAHA.115.06731.
5. Yu SF, Cheng JS, Chen YC, Chen JF, Hsu CY, Lai HM, Ko CH, Chiu WC, Su YJ, Cheng TT. Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study. BMC Geriatr. 2019 Oct 28;19(1):290. doi: 10.1186/s12877-019-1278-9.
6. Ruppar TM, Cooper PS, Mehr DR, Delgado JM, Dunbar-Jacob JM. Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta-Analysis of Controlled Trials. J Am Heart Assoc. 2016 Jun 17;5(6):e002606. doi: 10.1161/JAHA.115.002606.