Women In Government Actions

November 2011

At Women In Government’s Second Annual Healthcare Summit legislators learned more about the role of community pharmacists in delivering healthcare services and improving patient compliance and outcomes. Linda MacLean is a respected leader in the pharmacy community who has worked extensively over the past three decades to improve and expand her profession. She is a licensed pharmacist, a certified diabetes educator, a Clinical Associate Professor with the Washington State University (WSU) College of Pharmacy, and currently serving as the Associate Dean for Professional Education and Outreach at WSU. She spoke about how community pharmacists can do more for their consumers by establishing new models for community pharmacy practice and implementing patient-centered collaborative care. To learn more, please view her presentation here.

Additional Information

What is patient noncompliance?

Medication noncompliance occurs when a patient does not properly adhere to the medication regime prescribed for a treatment. 

The five most common types of noncompliance are:

• Not having the prescription filled; 
• Taking an incorrect dose;
• Taking the medicine at the wrong time;
• Forgetting to take one or more doses; and, 
• Stopping the medication too soon.[1]

Factors impacting noncompliance are:

• The rising cost of medication;
• Breakdowns in physician communication;
• Changes in medication; and, 
• Treatment fatigue.

Why is it important to take drugs as prescribed? 

Although prescriptions only comprise five percent of our total healthcare expenditures, these medications can result in the prevention of more expensive medical treatment.[2] On average, patients who are noncompliant with their medication regimen pay three times the average costs in annual doctor visits and more than $2,000 in out-of-pocket healthcare costs each year.[3] For those suffering from chronic disease, the economic effect of noncompliance is the greatest. And researchers have documented especially high rates of noncompliance for epilepsy (30-50 percent), diabetes (40-50 percent), hypertension (40 percent), asthma (20 percent), and anticoagulants (30 percent).[4] 

What are the consequences of noncompliance?

For chronic conditions that require medication to be controlled, the symptoms of the illness increase. This then results in increased doctor visits, an adjustment to a more expensive medication, additional tests, emergency room visits, and even hospitalizations. All of these factors increase the economic cost of the illness on the patient.[5] 

What can be done to reduce noncompliance?

Researchers have found that compliance studies are most successful among patients who are emotionally stable, have internal and external motivations, perceive a benefit to the drug therapy, and have a supportive social and family structure. Promoting these factors is important in increasing medication compliance.[6]

In Europe, electronic reminders have proven successful in improving compliance rates. These messages can be delivered in a variety of methods, including by phone, e-mail, or text messaging. These reminders can include reminders to take medication or even specific dosing instructions, and can be sent to caregivers or other loved ones who need to be notified about the patient’s medication schedule.[7]

In 1999, Missouri’s Medicaid program provided wireless reminders to diabetes patients by pagers. The cost to Medicaid was an average of $3416.28 less per patient per year compared to those who did not use pagers. And those who used pagers had an increase in claims of eight percent compared to the increase in claims of 21 percent by those without a pager.[8]

Sample Legislation in the States:

At Women In Government’s Western Regional Conference in July 2009, California Board of Pharmacy Executive Director Virginia Herold discussed California’s “drug labeling project.” Below are samples of draft drug labeling regulations from California’s Board of Pharmacy. In addition to these regulations, the enacted bill that allowed for these regulations to be implemented is also below.

California’s Drug Labeling Draft Regulations

California's Senate Bill 472 - Drug Labeling

Other tips that can improve compliance are:.

• Educating the patient about the drugs, their intended use, and their expected side effects;
• Building a partnership between the patient and the physician to understand the treatment goals;
• Encouraging an environment where the patient feels free to ask questions; and,
• Discussing financial assistance programs that may pay for prescriptions, [9] such as:
  • Patient Assistance Now;
  • Together Rx Access Program ;
  • Partnership for Prescription Assistance ;
  • NeedyMeds.com ; and
  • Rx Outreach .

Patient Compliance FAQs

Patient Compliance Handout