NCPIE outlines steps to improve adherence among elderly, polychronic patients

WASHINGTON — Calling it a "looming threat," the National Council on Patient Information and Education released a 10-step plan to draw attention to the problem of poor medication adherence among elderly people with multiple chronic conditions.

The report, titled "Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda," found that poor adherence among patients with chronic and comorbid conditions is resulting in disease progression and complications, as well as increased uses of more expensive healthcare services like emergency room visits, hospitalizations, re-admissions and post-acute care. Caring for about 27% of Americans with multiple chronic conditions accounts for 66% of the country's health expenditures and is a major source of Medicare spending. Patients with six or more chronic conditions accounted for about 14% of the Medicare population and cost $32,658 per patient, or three times the national average, the report found. As a result, the cost of treating them was more than $140 billion, out of $300 billion in Medicare spending overall. Forty-two percent of elderly people took five or more drugs in 2012, with the average number of drugs increasing from five at age 65 years to seven at age 85 years.

"Although the challenge of poor medication adherence has been discussed and debated extensively, what is lacking is the clear recognition that prescription medicine use and the rising prevalence of chronic and comorbid conditions are inextricably linked and together represent a major opportunity to address this health threat," NCPIE EVP Ray Bullman said. "This report is intended as a wakeup call that action is needed now to confront this combined threat, before the continuing upsurge of chronic conditions overwhelms the healthcare system."

The 10 steps that the NCPIE outlined were:

1. Establish medicine adherence as a priority goal of all federal and state efforts designed to reduce the burden of multiple chronic conditions.


2. Establish the role of the patient navigator within the care team to help patients with multiple chronic conditions navigate the healthcare system and take their prescription medicines as prescribed.


3. Promote clinical management approaches that are tailored to the specific needs and circumstances of individuals with multiple chronic conditions.


4. Incentivize the entire healthcare system to incorporate adherence education and medication support as part of routine care for MCC patients.


5. Eliminate the barriers that impede the ability of patients with multiple chronic conditions to refill their prescription medicines.


6. Reduce the cost-sharing barriers for patients by lowering or eliminating patient co-payments for prescription medicines used to treat the most common chronic diseases.


7. Accelerate the adoption of new health information technologies that promote medication adherence.


8. Establish medication adherence as a measure for the accreditation of healthcare professional educational programs.


9. Address multiple chronic conditions and optimal medication management approaches in treatment guidelines.


10. Stimulate rigorous research on treating people with multiple chronic conditions, including focused research on medication adherence to promote the safe and appropriate use of different medicines in this patient population.

The NCPIE includes the National Association of Chain Drug Stores, the National Community Pharmacists Association, Cardinal Health, McKesson Corp. and others.