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Doctors Should Screen Patients to Assess Consistency in Taking Prescribed Medications, Pitt Professor Recommends

PITTSBURGH, May 22, 2013 – Doctors should assess their patients to determine if they are consistently taking prescribed medications for long-term ailments and treat patients’ non-adherence behaviors as they would other medical problems, according to a University of Pittsburgh School of Medicine article published today in the Journal of the American Medical Association.
Between 30 and 50 percent of U.S. adults do not adhere to long-term medication regimens, leading to an estimated $100 billion in preventable costs annually, noted Zachary A. Marcum, Pharm.D., M.S., assistant professor of medicine in the Division of Geriatric Medicine at Pitt and corresponding author of the paper. Despite the widespread prevalence and cost of medication non-adherence, the problem goes undetected and undertreated in a significant proportion of adults.
“We propose medication non-adherence be viewed as a diagnosable and treatable medical condition,” said Dr. Marcum. “The first step is to conduct routine screening that will allow us to identify this condition.”
While there are reliable screening tests to “diagnose” medication non-adherence, the authors noted most clinicians are not formally trained to do this or on how best to treat the problem if detected.
They also noted that diagnostic accuracy can be improved by focusing on some of the most common underlying patient factors that often lead to non-adherence:
  • a lack of understanding that medication adherence fosters improved health
  • a belief that the cost of a medication is not balanced by its benefit
  • complex or confusing regimens that are hard to follow
  • lack of vigilance in taking medications regularly
  • inaccurate, irrational or conflicted beliefs about medications
  • perceptions that medication isn’t working
“Each medication non-adherence behavior requires different diagnostic tools and treatments, in the same way that specific medical conditions require specific treatments,” added Dr. Marcum. “An incorrect diagnosis can waste resources and cause harm to the patient.”
Educational interventions with behavioral support and regular patient outreach can significantly improve medication adherence for diseases such as hypertension and myocardial infarction, the authors noted. They also suggested that medication non-adherence be included in electronic health records to allow for sharing of information among health care professionals and monitoring of trends over time.
The authors plan future research to formally test this approach to diagnosing and treating medication adherence.
Co-authors of the article include Mary Ann Sevick, Sc.D., R.N., and Steven M. Handler, M.D., Ph.D., also of the University of Pittsburgh.

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