Patients with chronic conditions like asthma, diabetes, and cardiovascular disease often require emergency attention and hospitalization due to non-adherence, resulting in higher treatment costs.
In 1985, former Surgeon General C. Everett Koop announced, “Drugs don’t work in patients who don’t take them.” Nearly four decades later, one of the most critical challenges still facing our healthcare system is that only 50% of patients with chronic illnesses take their medications as prescribed.
Patients with chronic conditions like asthma, diabetes, and cardiovascular disease often require emergency attention and hospitalization due to non-adherence, resulting in higher treatment costs. All told, poor adherence to long-term therapies is the most significant modifiable factor limiting effective chronic disease management.
The global medication adherence market is growing, and quickly: projected to reach $6.0 billion by 2025, growing with a CAGR of 11.4% during the next five years. The increased prevalence of chronic diseases, an aging population, a growing acceptance of digital health technologies, and more personalized forms of healthcare are all responsible for this growth. While non-adherence is mediocre in developed countries, adherence rates are even lower in developing countries.
The COVID-19 pandemic has illustrated the costs and dangers of non-adherence. Those with chronic conditions including diabetes, COPD, and CHF are at higher risk of COVID infection, and have higher odds of adverse outcomes. There is a growing awareness in the market that these patients must effectively manage their conditions in order to mitigate the effects of COVID-19.
Nevertheless, across the entire healthcare industry, the way medication adherence is measured is almost always inaccurate. These methods — medication possession ratios, pill counts, electronic pill bottles —are all based on the notion that we are not able to truly measure dose-by-dose adherence. The most pervasive of these indirect measures includes “primary adherence,” indicating whether or not a person possesses a prescription. But a true measure of medication adherence must assess whether or not a patient ingests each and every dose as prescribed, rather than if they possess the medication in their pocket.
While the healthcare industry is ripe with companies that purport to improve medication adherence, traditional programs in pharmacy services and disease management do not observe ingestion, verify dosage, monitor side effects, and provide human support.
Measuring dose-by-dose adherence is made possible by a validated, decades-old public health solution called Directly Observed Therapy (DOT), where a trained healthcare worker watches the patient take each dose. Considered the standard of care for tuberculosis (TB) treatment, DOT is practiced daily by public health experts all over the country, with astounding accuracy and success.
While DOT has been perceived as impossible to scale, burdensome to fund, and inconvenient for both patients and care teams, technology now enables DOT to be scaled with comparable high adherence rates. Video DOT enables patients to video themselves taking their medication and to engage with their care providers, a continuation of the system that involves case management, coordination of medication delivery, and compassionate coaching and support by healthcare professionals who keep people motivated to stay on track.
Countries like the United States benefit from active and competitive healthcare markets offering digital solutions and adherence programs, but also continue to face cumbersome regulations that do not reflect the rapidly evolving role technology plays in the healthcare industry. The global challenge of medication adherence requires a global solution, with programs and technologies available even in countries with limited technological infrastructure and with varied regulations. We cannot afford to solve the problems of medication adherence only for the countries whose capabilities give them an advantage.
We know that improving adherence can not only help avoid human suffering, but also help prevent excess economic costs associated with increased utilization of healthcare services. But our vocabulary around medication adherence must quickly catch up to technological readiness. Given that more than half of adult Americans have more than one chronic condition, we must change the way we measure medication adherence in the industry to ensure we can effectively address today’s health crises.
Sebastian Seiguer is CEO of emocha Health.