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The Next Frontier of Improving Medication Adherence

June 07, 2016

Medication nonadherence is recognized as one of the most important and costly worldwide health care problems in the 21st century.1 The comprehensive 2003 WHO report on adherence to long-term therapies noted, “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.”2,3 In the United States, an estimated $100-$290 billion in preventable costs can be realized by improving the 30%-50% adult non-adherence rate to chronic medications.4 The Congressional Budget Office estimates that a 1% increase in the number of prescriptions filled by beneficiaries would result in a reduction of a 1/5 of 1% of total Medicare spending on services.5

Could we improve medication adherence by sharing medication refill data directly with patients online? Potentially. We can learn from our physician colleagues who have started sharing their medical notes with patients. A recent study called OpenNotes, an innovative on-line program to share medical notes with patients online that was launched in 2010 by Beth Israel Deaconess Medical Center in Boston and funded by the Robert Woods Johnson Foundation and other charitable organizations, involved 105 primary care physicians and 13,564 patients at 3 sites in Seattle. At the beginning, 92%-97% of patients, and 69%-82% of physicians thought this was a good idea.1 After 1 year of follow-up, of access to physician notes online, 99% of patients and 85%-91% of physicians agreed that this was a good idea.6 There are now more than 100 health care institutions in the US who have begun to implement this type of program of sharing notes with patients.

Does this process engage patients to be more involved with their health? The answer is yes. In a mixed methods qualitative study including survey data, quantitative-descriptive measures combined with semi-structured individual interviews, patient activation measures and member checks in Boston, the authors found that with patients use of fully transparent medical records, patients better understood their medical condition, took better care of their health, and had a better relationship with their physician.7

Could an OpenNotes process work to improve medication adherence by publishing direct online adherence rates with patient-directed medication information by community pharmacy organizations?  The answer needs to be explored by exploratory research methodology. But why not? Medication adherence is one of the major healthcare problems facing the US and is in need of patient-directed solutions. Community pharmacy should be at the forefront of finding solutions. This may be one of them that engages patients, increases medication adherence, and improves healthcare outcomes for millions of Americans.


Mark A. Munger, PharmD, FCCP, FACC, is a Professor of Pharmacotherapy and Adjunct Professor of Internal Medicine, at the University of Utah, where he also serves as the Associate Dean, Academic Affairs for the College of Pharmacy.



1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005:353;487–497.

2. World Health Organization. Adherence to long term therapies: Evidence for action. Geneva, Switzerland: World Health Organization. 2003.

3. Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications. Cochrane Database of Syst Rev. 2002;(2)CD000011.

4. Marcum ZA, Sevick MA, Handler SM. Medication nonadherence: a diagnosable and treatable medical condition. JAMA. 2013;309(20):2105-2106.

5. Elmendorf DW. Offsetting effects of prescription drug use on Medicare’s spending for other health care services. Congressional Budget Office. November 29, 2012.

6. Walker J, Leveille SG, Ngo L, et al. Inviting patients to read their doctor’s notes: Patients and doctors look ahead. Ann Intern Med. 2011;155(12):811-819.

7. Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctor’s notes: A quasi-experimental study and a look ahead. Ann Intern Med. 2012;157(7):461-470.

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