NEHI calls for team-based approach to improve drug adherence

CAMBRIDGE, Mass. — Poor medication adherence is one of the nation’s “most persistent” healthcare problems, costing the U.S. health system as much as $290 billion a year, or 13% of total health expenditures, according to the New England Healthcare Institute. In response, the nonprofit organization is calling for an urgent national campaign to improve adherence through a team-based, collaborative approach to long-term patient therapy.

In a widely circulated report, NEHI is urging the health system to launch a series of demonstration projects to test the viability of patient care teams as a more effective way to deal with the problem. Such teams would merge the oversight and skills of both physicians and “non-physician caregivers, including professionals such as community pharmacists,” to “serve as part of a ‘virtual care team’…in a wide variety of practice settings,” according to the report.

“It is time to test adherence solutions through teamwork,” NEHI urged. “Poor medication adherence is exacting a heavy toll in the form of unnecessary illness, disability and premature mortality, particularly among the burgeoning number of chronically ill patients.”

The aging population and the rise in such chronic conditions as diabetes and hypertension “will result in both a greater need for treatment by prescription medication and, if nothing is done, greater nonadherence,” the report continued.

Diverse size, unequal resources within U.S. physician practices

PRACTICE SIZE %OF PHYSICIANS %OF PRACTICES
Solo 36.8% 69.4%
Partner 12.1 11.4
Three to five 27.8 14.4
Six or more 23.4 4.9
SPECIALIZATION %OF PHYSICIANS %OF PRACTICES
Solo or single-specialty group 78.8 90.1
Multi-specialty group 20.3 8.9
Unknown 1.0 1.0
EMR USE %OF PHYSICIANS %OF PRACTICES
Full 12.8 9.2
Partial 13.7 12.7
None 73.5 78.2
ADHERENCE-RELATED EMR FEATURE %OF PHYSICIANS %OF PRACTICES
E-prescribing 11.9 NA
Warnings on drug interactions 14.6 NA

 

Also spurring such new approaches as health teams, NEHI said, is the fact that “the U.S. healthcare system appears poised to embrace system-changing innovations” like health information technology, patient-centered “medical homes” and “accountable care,” also known as outcomes-based or evidence-based medicine.

The group’s answer: “the coordinated implementation of both multiple steps and multiple interventions” that include “techniques for patient identification and screening,” as well as medication reviews by pharmacists and “interventions to reduce cost barriers for individual patients.” NEHI also recommended “patient education and engagement techniques” and “the integration of…adherence strategies with other elements of healthcare reform.”

That includes “the deployment of electronic medical records, feedback loops and data-sharing systems that will allow the…private exchange of patient medication-related data among care team members,” noted the report.

To pay for such programs, NEHI suggested the use of both private investments and “complementary programs created by the Patient Protection and Affordable Care Act.” In addition, new payment models could “enable and reward investment in the delivery of medication adherence services through care teams,” the NEHI report stated.

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