Helping Improve
Medication Adherence

Medication Adherence Helps
Reduce Hospital Readmissions

Hospital patients have a lot to remember when they leave the hospital, like self-care instructions, follow-up appointments, and medication changes. Remembering things like this is tough for healthy people, but trying to remember it all when you’re sick or in pain makes understanding a care plan much more difficult.

When patients don’t understand (or correctly remember) their medication instructions, they may take medication incorrectly, or not at all. Studies show that approximately 50% of patients don’t take their medication as prescribed.

Medication non-adherence can cause serious injury to patients and leads to a fifth of hospital readmissions. These readmissions contribute to another expensive problem: Unplanned readmissions cost $20 billion annually.

These costs can go unreimbursed since the CMS Hospital Readmissions Reduction Program cuts hospital payments based on readmission rates for certain conditions. Many of these conditions are medication-dependent, like heart failure. Patients with heart failure can quickly become fluid-overloaded if they don't take diuretic medication, which can lead to an unplanned readmission. In fact, one study found that medication adherence was the best predictor of whether these patients would be hospitalized.

Medication adherence is extremely important, so how do you help ensure your patients are following their care plan and taking their medications as prescribed?

Factors contributing to medication noncompliance

The first step in ensuring patients use their medications safely and correctly is identifying the reasons why they might not adhere to their medication regimen. There are many reasons a patient may not use medication safely.

Misunderstanding. Keeping track of everything after hospital discharge is challenging, especially when facing a new diagnosis. Medication use involves many details, and patients may not understand what they should take and how to take it.

Side effects. Patients sometimes stop taking medications because they don’t like the way they feel. Sometimes medications are stopped as soon as the patient feels better.

Financial constraints. Some patients simply cannot afford their medications.

Pharmacy stock and insurance. Stock issues and insurance denials can make it difficult to get medication or refills.

Mental health. Medication non-adherence in mental health patients is a significant problem that can lead to worsening health conditions.

Transportation. Driving to the pharmacy to pick up a prescription can be out of reach for someone with limited resources.

Identifying the root cause of non-adherence can help the care team address these problems proactively.

Next steps:

Educate for medication safety after discharge

To follow a medication plan, patients must understand what medication they need, how to take it, and why it is important. Cover all these aspects when educating patients.

Research shows that patients forget 40% to 80% of the medical information they are taught. When they do remember, almost half the information they report is partly incorrect. Giving patients written information at discharge greatly improves medication adherence. Be sure to include:

• Medication lists, schedules, and calendars

• Materials describing the purpose of medications and side effects

• Information on smartphone apps and other tools to track medication use

For better retention when teaching, engage patients and family members in an active discussion using the teach-back technique. Teach-back has been extensively studied and improves recall and understanding by at least 37%.

To use teach-back, ask patients to restate what you told them with a statement like, "Tell me which three medications you are taking for heart failure and why you are taking them."

Do this frequently. Teach-back encourages conversation and is an excellent opportunity for questions.

Handle prior authorizations

Picture this: At discharge, a patient’s prescription is sent to their pharmacy. Insurance requires prior authorization, and the pharmacy requests one from the prescribing doctor's office. But the office doesn't have the staff to complete it immediately or they have new staff who haven’t been trained in prior authorizations. They miss sending some information. After a denial and an appeal, it goes through, but the patient has gone three weeks without getting the medication they need. 

This situation is not uncommon.

94% of physicians report treatment delays with prior authorizations, sometimes with profound consequences: 25% say a prior authorization delay has led to rehospitalization, and 33% say the delays have caused harm, including death.

Use these strategies to minimize prior authorization delays:

Start early. Send prescriptions a few days before anticipated discharge to give time for prior authorization.

Use a dedicated team. A team with expertise in prior authorizations can complete them efficiently and accurately.

Keep communication open. Timely communication between the prior authorization team and the prescribing doctor can minimize delays with alternative prescriptions if needed.

Meds to Beds. Encourage patients to use a Meds-to-Beds program to ensure patients receive their medications directly to their bedside before they leave the hospital.

Assistance with insurance, pharmacies, and hardships

As of 2022, 27.6 million Americans remained uninsured. For people with insurance, high copays or pharmacy stock issues can be barriers to getting medication. In 2023, drug shortages reached a 10-year high. In April of that year, a staggering 301 drugs were in short supply — 100 times more than at that same time five years earlier.

To help patients navigate these challenges, try these strategies:

• Stay knowledgeable about drug shortages and communicate them to prescribing physicians. The Food and Drug Administration (FDA) publishes a drug shortages list that updates daily.

• Local pharmacy stocks may vary. Check with them frequently.

• Consider offering a medication delivery program to provide patients with discharge prescriptions before they leave.

Potential financial resources include:

Insurance. Evaluate if uninsured or underinsured patients qualify for Medicare, Medicaid, or insurance through the health insurance marketplace.

State-sponsored programs. 48 states have pharmaceutical assistance programs that help specific patient populations.

Drug company-sponsored programs. Over 200 medications have patient assistance programs offered by their manufacturers.

Coupon cards. Check for prescription discounts through discount cards and direct pharmacy programs.

Hospital programs. Many hospitals offer medication assistance. The cost is often less than the cost of preventable readmissions, and such programs help nonprofit hospitals meet community benefit requirements.

Follow-up

Patients will encounter questions and challenges at home. A follow-up phone call within 72 hours of discharge is a great opportunity to check for medication difficulties or problems obtaining medication. This follow-up call also helps improve patient satisfaction.

Conclusion

With proactive planning and communication, you can reduce medication-related readmissions. Teach clearly and provide written education materials to help patients understand how to use medications safely. Address insurance issues, shortages, and financial challenges for the best possible outcomes.