March 29, 2018
During a presentation at the PBMI 2018 Drug Benefit Conference, Patty Taddei-Allen, PharmD, Director of Outcomes Research at WellDyneRx, outlined some innovative multifaceted approaches to improving outcomes and costs in patients with type-2 diabetes.
Dr Taddei-Allen started her presentation by explaining some of the common reasons patients with type-2 diabetes struggle with adherence. She also outlined some strategies for improving adherence to both oral therapies and injectables.
She explained that 30% to 50% of diabetes treatment failures are due to non-adherence, with an estimated 125,000 deaths caused by non-adherence every year. She noted that this leads to avoidable health care costs, with non-adherence representing about $50 billion in yearly spending. Dr Taddei-Allen also said that most diabetes readmissions are due to poor adherence, with most patients dropping off of treatment after the first 6 months.
“Medications are great, if people would only take it,” she said during the presentation.
Dr Taddei-Allen, along with Nick Page, PharmD VP of Specialty and Clinical Operations at WellDyneRx, explained different terms related to adherence, including compliance—those show adhere to medication, persistence—the extent to which patients stay on a medication course, primary non-adherence—medications that are never filled, and secondary non-adherence—prescribed medications that are only filled once or twice.
They also noted that non-adherence usually trigger hypoglycemia and can cause other comorbid health conditions like obesity.
Reasons for non-adhernce are often financial or the result of polypharmacy. These include high copays. High need for different medications each day, and confusion. Patients can often also become non-adherent during hospitalization, when they are switched to different agents based on the hospital’s formulary.
Dr Taddei-Allen explained a course of action that can help stave off adherence issues. This step-by-step practice included simplifying a patients mediation regimen, explaining the importance of adherence, modify patient behaviors or beliefs, provide communication and trust, leave the bias, and evaluate and monitor adherence.
Simplifying the regimen requires personalizing the medicine by working it into the patients daily life. Connecting patients with resources like pill boxes, cell phone alarms, and apps can help them manage their medications.
Modifying behavior and imparting knowledge require engaging with patients to get an understanding of how they feel about their treatment. Motivational interviewing techniques can be used to modify behavior. Also, providers must identify the largest barriers to adherence for each patient without assuming.
Dr Taddei-Allen recommended closed formularies that drive patients to higher rebates on targeted medications. She also concluded that in order to improve costs and outcomes, risk stratification needs to be applied to engage the highest-risk patients with disease management interventions.
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