• 03 Aug 2015

    Comparing Patient Challenges: Determining Unique and Universal Challenges to Prescription Adherence

    Jennifer Rawding, Senior Analyst, Zitter Health Insights

    In a previous blog post, we focused on the primary drivers of prescription abandonment for rheumatoid arthritis patients. But do these patients face different challenges than other patients? We’ll compare data from the Abandonment Insight Monitor’s recent survey of over 1,000 asthma, chronic obstructive pulmonary disease (COPD), hepatitis C (HCV), multiple sclerosis (MS), rheumatoid arthritis (RA) and diabetes patients to examine which challenges patients face across various disease states share, and which are unique.

    The decision of a patient not to fill a new prescription is what we call primary abandonment. Hepatitis C patients had the highest rate of primary abandonment (21%), while diabetes patients had the lowest (9%). In many cases, hepatitis C does not display symptoms until liver disease becomes advanced, which may cause patients to be more likely to delay treatment. Conversely, diabetes medication is typically prescribed when diet and exercise are no longer adequately maintaining blood glucose and insulin levels, so there is a more immediate effect of delaying treatment. Concerns about cost and side effects appear to be the main drivers of primary script abandonment across most disease states; the former is the primary reason for abandonment for COPD, HCV and diabetes patients, while the latter is the primary reason for script abandonment for asthma and MS patients. However, RA patients most frequently cite a lack of readiness or information from self-research as driving their decision not to fill a new prescription. Addressing patients cost and safety concerns prior to first fill, as well as making sure they have enough information to feel comfortable beginning treatment, is essential to decrease primary abandonment.

    Patients are faced with adherence decisions every day. Which challenges do they face when trying to take their medications as directed? Asthma and COPD patients were the least likely to have taken their last dose as directed (20% and 17%, respectively), while MS and RA patients were the most likely to have done so (93%). Asthma and COPD patients may incorrectly believe that they only need to take their chronic medications on an “as needed” basis. Whereas RA patients can feel the immediate effects of non-adherence in the form of pain or decreased mobility. Across all therapeutic areas, forgetfulness was the primary reason that patients did not take their medication as directed. This suggests that a dose reminder program or adherence-focused app could be extremely useful in ensuring patients are taking their medications as directed.

    The final decision a patient faces on a brand is whether or not they will continue filling their prescription—what we call secondary abandonment. Across disease states, this is much more common than primary abandonment; this shouldn’t be surprising, as patients often switch brands to find the medication that works best for them. RA patients had the lowest rate of secondary abandonment (38%), while COPD patients had the highest (66%). Given the high rate of non-adherence for COPD patients (17%), patients may not be taking their medication correctly, causing them to think their medication is not working and cycle through brands more quickly. In fact, the perception that their medication was not improving their condition was the most frequently reported reason for secondary abandonment in Asthma, COPD, MS and RA. Intolerable side effects were the primary reason for abandonment for HCV and diabetes patients. Effective strategies to decrease secondary abandonment could include clearly communicating the importance of adherence, setting reasonable efficacy expectations and developing side effect management plans at the time of prescription.

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    While many of the challenges patients face are universal, understanding the nuances between disease states can help inform strategies to decrease non-adherence and abandonment. Stay tuned to learn how the unique challenges patients face at the pharmacy can impact their fill decisions!