How Adherence to Medication Lowers Healthcare Cost in Crohn's and Colitis Patients

Take medications as they are prescribed. It sounds like such a simple concept, but it isn’t. Medication nonadherence continues to be a problem in the United States. It causes people to not only remain unhealthy, but it puts a huge strain on health care costs. When it comes to children, many wouldn't expect nonadherence to be an issue. Unfortunately, it is. An adult has a choice on whether to take their medications or not; a child doesn’t. It seems like no big deal to some people to stop medications on their own or adjust their doses. It is a huge deal from a health standpoint and a financial one. Recent studies were able to prove the effects of nonadherence in pediatric patients with Inflammatory Bowel Disease. The results speak for themselves.

Inflammatory bowel disease refers to an ongoing inflammation of the digestive tract. The two common types are Crohn's Disease and Ulcerative Colitis. Medications used to treat the disease are usually taken daily and for long periods of time. For people that are affected by Inflammatory Bowel Disease, this sometimes can be a major problem. These types of conditions can cause severe flare-ups where medication is a must for relief. These diseases, however, also have a time of remission. During these times, patients may experience no symptoms at all. It is for these reasons that medication nonadherence can become an issue. Some patients feel they do not need to be on medications unless they are having physical symptoms of an illness. This may be part of the explanation for the nonadherence in pediatric patients especially.

Nonadherence

Nonadherence is a term that describes people who fail to comply with medications given to them. If there is a legitimate condition that needs medication then it isn't complicated. If a physician feels you will benefit from treatment, follow the doctor's orders. For some people, it’s not that easy. People stop taking medications for a number of reasons and it happens a lot. People become ill and need something to feel better. When they feel better, they tend to feel like they no longer require medication. A lot of people have trouble adjusting to life on medications. Some can’t afford to buy their medications which can lead to nonadherence. Other patients don’t want to take chemicals or treatments that aren’t natural. Elderly patients or patients suffering from neurological disorders may simply forget to take their medications. Whatever the reason may be, it has become a widespread problem.

The New York Times ran an article in April of this year about medication nonadherence, titled appropriately, “The Cost of Not Taking Your Medication”. It describes nonadherence as an “out of control epidemic”. According to the article, there is ongoing data that shows 20 to 30 percent of prescriptions given to patients are never even filled. The amount of deaths that occur from nonadherence are even more unsettling. The article states that there have been around 125,000 deaths associated with this problem. The dollar amounts of the cost this issue has on healthcare are astounding. The report shows costs to healthcare to be in the range of $100 billion and $289 billion a year! No wonder so many are frustrated with nonadherence, and it is a problem that doesn't even need to exist.

Pediatric nonadherence

No parent wants their child to have to take pills every day, especially if they are not sick at the moment. Pediatric patients with Inflammatory Bowel Disease are at the same risk as adults. Statistics show that costs associated with hospitalizations of these patients are in the range of $150 million. When all medical expenses were totaled for these patients it reached $450 million per year. The Cincinnati Children's Hospital Medical Center recently conducted a study. Their goal was to find out if nonadherence to medication in pediatric patients does, in fact, lead to increased healthcare costs.

The study was done over a period of two years. It included 99 pediatric patients with Inflammatory Bowel Disease. They examined refill records from pharmacies and medical records to determine the patient's severity of the disease, and hospital records to determine cost incurred by these patients. The study showed that the nonadherent group caused medical bills that were three times higher than those who were compliant most if not all of the time. Patients who weren't taking their medication at first but then began taking it consistently had numbers closer to those who remained adherent from the start. That information leads to the thought that it is possible to modify behavior when it comes to medications. In pediatrics, this is up to everyone to get involved, especially the parents.

What can doctors do?

The prescription process needs to be as simple as possible. For example, if a patient only has to take a pill once a day, it’s more likely to happen. Physicians need to make sure they are giving parents the most information as possible. They need to make sure parents understand the need for the prescription. They also need to provide detailed knowledge of the condition and ramifications of not taking these meds. A doctor visit doesn't last long. Schedules are tight and a patient is lucky to get ten minutes with a doctor out of a supposed 30-minute visit. If a patient goes in and is diagnosed with an illness, that is not a lot of time for questions and answers. Parents of patients may become anxious and can forget everything that was explained. Many have forgotten the prescription instructions by time then get out to their car.

Doctors need to work to identify patients who are at risk for nonadherence and react accordingly. More time needs to be spent with these patients to make sure they understand in full. Doctors need to ask the appropriate questions in order to determine if medication adherence is a factor. If parents continue to be noncompliant with their kids, then doctors should report accordingly. Pharmacies that fill the prescriptions can play a bigger role as well. A lot of times, the Pharmacy clerk will ask if there are any questions. Most people say no. If it’s a new prescription to the patient, an education session with a pharmacist or tech should be mandatory.

Get medications back on track!

People need to be educated further on the importance of taking medications as prescribed. This starts with filling prescriptions, refilling if necessary, and of course taking the pills as directed. What can parents do to help get kids on track with their medications?

Get educated! Know what medications are for and why they are needed. Learn the side effects and dosage. Take only the amount prescribed by the doctor. Take the medication until it is gone and refill if necessary. Do not stop a medication unless instructed by a doctor.

Get organized! If a patient is on a lot of pills, it's easy to get confused. There are large assortments of pill boxes that help. Use apps on smartphones or computers to help keep track of medications taken. Make it fun! Make a craft out of it! For kids, get out the construction paper and make a chart with stickers for meds that were taken.

And last of all, be on top of your medication! No one wants to be on medications, but the world is lucky to have them. It might be inconvenient and there may be side effects. If a medication is causing you unbearable side effects, discuss with your doctor. There could very well be alternatives.

References

https://www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html

https://ibdnewstoday.com/2017/07/11/adherence-medication-decreases-healthcare-costs-pediatric-ibd/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681370/