Medication adherence: Helping employees get the most from their prescriptions
Employers and their insurers spend a lot of time and energy considering new ways to make drug programs available to more people, to keep costs under control, and to make sure employees and their families have easier access to the drugs best suited to their individual needs – the medications that will help them achieve the best outcomes.
However, getting access to the right medications is just part of the journey. It’s equally important to support employees with medication adherence – that is, helping them find ways to take their medications as per their prescriptions. This includes supporting them to work with their doctors and pharmacists to understand how and when to take their medications, what they should do if they encounter difficulties following the prescription, and when to talk with their healthcare team to adjust if needed. As an employer, building this health literacy in your workforce will protect your drug plan investment, and can help keep employees feeling well so they can be at their best at work and in life.
Better outcomes through improved health literacy
Canadian research studies have shown that difficulty with adherence to prescriptions is very common.1 “A lot of people find taking medication as prescribed to be a challenge, and health literacy can play a role” says Dr. Steve Pomedli of Cleveland Clinic Canada, Manulife’s Medical Director. Dr. Pomedli says this can include:
- a misunderstanding of what the prescription is for
- not knowing how the medicine works, or
- why it is important to take the medicine on a regular basis.
“This can be true especially for underlying chronic conditions such as diabetes or high blood pressure,” adds Dr. Pomedli. “These conditions may not have any symptoms in the earlier stages, and thus the importance of taking the medication on a regular and ongoing basis may not be immediately clear to patients.”
Costs and other barriers
Across the country, cost can be an issue that prevents people from accessing key medications for acute illnesses, as well as medicines for chronic health conditions. Fortunately, health benefits plans make this less of an obstacle. However, even when individuals share a portion of the costs of medications from their own wallet, it can create a barrier to taking the prescriptions as intended.2
Dr. Pomedli observes, “Even when people have an insurance plan to cover the cost of the medication and are able to pick up their medication from the pharmacy, taking a single medication once a day can be hard to remember or keep track of. This can be even more challenging when someone is taking several different medications several times a day, or on different schedules. And for some medications, an individual may feel that a medication isn’t working, or that the side effects are making them feel worse. These situations warrant a discussion with their medical team to review the concerns, and they may require adjustment to the prescription.”
Digital health information tools help adherence
Today, there’s a range of technology available to help people manage their medications better: from the low tech (but still effective) pill box, medication journal, blister packs, or reminder calls from family members to newer, high tech digital tools, apps, and wearable devices that remind people when to take their meds. There are even systems that can alert the health care team when a patient has taken, or missed, a dose. But it’s important for patients to work with their health care team, and family and social support system, to determine the best system to meet their needs.
Electronic prescribing and tracking, versus paper prescriptions, has also helped reduce the number of prescriptions that aren’t picked up after an initial prescription. And these systems have made it easier to notify patients when it’s time to refill a prescription. Electronic prescriptions can also help physicians and other prescribers track when prescriptions have, or have not, been filled – and offer follow-up to support adherence.
Group benefits plan can improve adherence
Programs available through your organization’s group benefits plan can help patients better understand their medications and how and when to take them.
For instance, Manulife’s Virtual Health Coaching program pairs patients with a qualified coach who helps them find and set their own motivations for change. Through the client–coach relationship, patients receive personalized, one-on-one health guidance based on their unique needs. This could help with problem solving, breaking down goals into manageable steps, or simply having a coach to keep them accountable for developing routines to take their medications on schedule. Through this coaching support, individuals can have a better chance to achieve success by changing behaviours, better understanding their health, and learning how they can improve it.
Specialty medications, which are used to treat specific chronic medical conditions (including rheumatoid arthritis, Crohn’s disease, multiple sclerosis, pulmonary arterial hypertension, cancer, osteoporosis, and hepatitis C) can be particularly complicated to understand. Individuals can find themselves overwhelmed by special handling and storage requirements for the medication, complex instructions about how to take the drug, and there may also be potential side effects that need to be monitored or managed.
Through Manulife’s Specialty Drug Care program, patients prescribed a specialty drug are supported by an experienced Registered Nurse case manager. The case manager helps provide education and engages the employee in their own care. Employees become more informed and more confident in how and when to take their medications, so they have the best chance to get the most from their specialty drug treatment.
Manulife’s Opioid Management program helps individuals understand how to take these medications safely and as prescribed, and it helps minimize serious side effects. When an individual is prescribed an opioid, the pharmacist begins by dispensing up to a 7-day supply of medication. This helps lower the risk of opioid-related complications to individuals, families, and communities by:
- lowering the risk of side effects,
- reducing unneeded long-term use, and
- creating fewer unused opioids that are left over in households.
The costs of non-adherence
Medication non-adherence affects the well-being of your employees – and can have important implications on the effectiveness of your drug plan. Non-adherence includes situations when an initial prescription isn’t picked up or actually taken, when medications are stopped early, or when a medication is not taken as regularly as prescribed.
In a survey of Canadians with chronic health conditions, 61 per cent of respondents were not adherent with their prescriptions in one way or another.3 Patients who don’t fill their prescriptions, stop taking their medications early, or don’t take them as prescribed are at risk of not getting better or having the symptoms return.4
Dr. Pomedli says, “Many chronic conditions require regular dosing of one or several medications. Without regular dosing, the medication is less effective, meaning that the health condition, such as diabetes or high blood pressure, is less well-controlled, increasing the risk of major future health complications. This means higher rates of major illness and hospitalizations and increased costs to drug plans and public health systems.”
Influence your plan members to become empowered and involved in their care
Changing habits around the way people approach medication is an important part of health literacy. We’ve prepared these general reminders and tips for you to share with your employees through your usual employee newsletters, intranet site, or other staff communications.
This information has been prepared by Manulife and its Medical Director, Cleveland Clinic Canada.
Taking medication as prescribed by your doctor or pharmacist
Our organization’s drug plan provides funding for the medication you and your covered family members need to maintain your health and well-being. Here are some helpful reminders about why medications should be taken as prescribed by your doctor and pharmacist. These reminders are for your general education. Every situation is unique – if you have questions or concerns about your specific situation, speak with an appropriate health care professional.
For a variety of reasons, many people may not take their medication as directed by their health care team. This may be due to not understanding why a medication is important, or why a medication should be taken as prescribed. Some medications also produce side effects that individuals may want to avoid. Additionally, it can be hard to remember to take a medication on a regular basis.
However, not picking up a prescription or not taking a medication as prescribed has been linked to many worsening health outcomes. These include prolonged illness, lower quality of life, more serious health complications in the future, and can also lead to higher costs for you, your drug plan, and the health care system.2,3
Do you have questions about how to take your medicine? How much? How often? Or for how long?
Medications (and healthcare in general) can be complicated and sometimes difficult to understand. It can be easy to get nervous or intimidated when visiting a doctor or pharmacist and you might leave with unanswered questions. If you don’t feel you understand the reason for a medication, how to take the medication, or have questions about how the medication will improve your health, be sure to reach out to your doctor or pharmacist. Make notes before or during the visit, or have a loved one accompany you, so you have a second set of ears and eyes. And if you think of something after your appointment, don’t delay in reaching out. A quick phone call or e-mail can often get you the information you need.
Continue medications for the time prescribed
It can be common for people to stop taking a medication (or take it less often) when they begin to feel better. But you might risk getting sick again if you stop too soon. If you feel like stopping a medication before the end of a prescribed course, be sure to talk to your healthcare provider or pharmacist about your concerns so they can give you the best advice.
If your medicine doesn’t seem to be working or makes you feel worse, speak to your doctor or pharmacist
Sometimes, medications might not immediately make you feel better, or may make you feel worse because of unpleasant or even serious side effects. If you feel you are experiencing particular side effects, follow the instructions on the medication’s packaging. And in all these cases, reach out to your pharmacist or doctor. They will review your concerns and symptoms, and they may talk to you about options to adjust your dosage, the frequency that you take your medicine, or the type of medicine you are taking. There might be other additional approaches to managing your condition that you can explore with your doctor.
Remember to take your medicine
One of the most common reasons people don’t take their medicine is that they simply forget. Fortunately, there are tools and strategies you can try to help you remember. From simple pill boxes, reminder notes, medication journals, calendars, and cues from loved ones to digital tools that allow you to program reminders into your phone or computer, wearable devices, and/or apps on your smart phone.
“Habit stacking” is another strategy to explore. Habit stacking is a technique in which you create a new habit by associating it with a current habit, such as taking your medicine after brushing your teeth or immediately after your morning shower. Learn more about habit stacking and other helpful ideas to see which one makes it easier for you to stay on top of your medications.
2Failure to Take Meds Leads to Worsening Health Outcomes and Increased Costs to Health Care - English (pharmacists.ca), 2015
4CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities | MMWR, 2017