Cost, Poor Communication Key Barriers to Medication Adherence

By Sara Heath

September 07, 2021 - Drug costs, patient education, and patient-provider communication are leading factors in poor medication adherence, according to new data published in the Journal of the American Geriatrics Society.

Particularly, about two-thirds of adults with non-ventricular atrial fibrillation (AF) said healthcare costs were the leading factor behind their poor medication adherence, the researchers from the University of California Los Angeles (UCLA) and San Diego (UCSD) said.

Medication adherence is a billion-dollar problem in the chronic disease management space. Regardless of the forces behind medication non-adherence, patients who do not take their medications run the risk of seeing their conditions deteriorate and experiencing acute care episodes.

For patients with AF, taking direct-acting oral coagulants (DAOC) can help managing illness, but currently medication adherence rates leave much to be desired. The researchers noted that medication non-adherence for DAOC runs anywhere between 26 and 45 percent.

And rarely are the reasons behind that non-adherence patient refusal or non-compliance. Rather, a survey of 42 patients with a mean age of about 70 years old showed a number of patient engagement issues contributing to low medication adherence.

Healthcare, drug costs

Foremost, patients cited drug costs as a leading factor in low medication adherence.

“Of course, I'm sure everyone's going to tell you that the cost of Eliquis is absurd,” one patient respondent said.

For some patients, simply the high price tag was enough to limit medication adherence or discourage filling the prescription at all.

“If the insurance would have paid for it, I would have been taking it,” another patient said.

However, for many patients it was the complexities of the healthcare industry in general, and the lack of support they perceived from the prescribing provider, that got in the way. Particularly, many patients said their providers did not offer much guidance about healthcare costs, and when they did get a coupon for their medications, it was not valid or did not work.

Patient safety, side effect concerns

Outside of cost limitations, patients said they were concerned about patient safety and side effects, particularly as it relates to bleeding. While some patients said they engage in activities that were higher risk for injury and for which excessive bleeding would be a likelihood, others were deterred by past experiences from family members and friends.
“Risk of hemorrhage, risk of bleeding especially if you fall and hit your head. I live alone. I really didn't want to have to be on it,” one patient respondent said.

Lack of symptoms, no perceived need

For some patients, low medication adherence stemmed from a perceived lack of need. These patients said they were not experiencing AF symptoms and thought their risk of stroke was low.

Perceived safety in skipping doses

Some patients believed their symptoms manageable enough not to take the full dosage. These patients were not entirely medication non-adherent—they did fill the prescription and were taking some pills—but they did not take their medications regularly because they did not think they needed to.

Relatedly, some patients said they skipped doses to stretch their prescriptions as a cost-cutting measure.

Confusion about efficacy

Although not meant to tamp down on AF symptoms entirely, some patients began tapering off medication because they still experienced symptoms. In other words, they did not believe the medication was working.

“I'm not saying it didn't do anything, but I'm saying I still had [atrial fibrillation] episodes here and there,” one patient reported.

Incomplete patient-provider communication

For many patients, incomplete patient-provider communication and patient education about the drug limited uptake. These patients said their providers did not offer explicit enough instructions about taking their medications and did not ask about medication adherence during appointments.

“I don’t normally tell him I missed a dose,” one patient remarked. “If he asked, I would tell him.”

Other patients said they received different information from the provider who did not prescribe the medication, causing some confusion.

“[I had a physician tell me that I] didn't need to be on [apixaban] anymore. Now this new, this other doctor just said, ‘Yes, you do [have to take it] and you'll need to be on it the rest of your life. Once you have Afib, you have to be on it,’” another patient stated.

Using patient engagement, education to overcome barriers

Many of these barriers could be overcome with strong patient engagement and education. Although clinicians have very little control over drug pricing, they can determine lower-cost options for patients if the clinician opens up this line of conversation.

After all, a highly effective medicine is not effective if the patient can’t afford it. Going with a potentially less effective but more affordable option could be more beneficial.

With regard to limited perceived need, fears about side effects, and incomplete patient-provider communication, healthcare providers have opportunity for growth. Using clear patient education about treatment options, including the risks for side effects and the realistic results of a therapy, will be essential for helping patients better understand.

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