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An Unrecognized Opportunity to Improve Health, Reduce Costs

By Bruce Bender, PhD

In the national debate about health care and its rising costs, there is a substantial opportunity that few even recognize. Simply put, patients do not take their prescribed medicine, with dramatic consequences for their health and our national pocketbook. Wider recognition of this simple fact and a focused effort to address it could save, over time, millions of lives and billions of dollars.

Numerous studies over the years have shown that large swaths of the American public do not take medications as prescribed. Many people start out with good intentions, but soon abandon treatment. People with chronic diseases such as asthma, diabetes and heart disease are especially delinquent, often taking less than half the prescribed dosage. A recent study showed that even after an acute event, such as a heart attack, patients took only 41 percent of prescribed blood-pressure medications and 55 percent of lipid-lowering statins. Another study documented that a third of kidney transplant patients were not taking anti-rejection drugs properly two years after their operations.

People who don’t take their medications suffer more hospitalizations, urgent doctor visits, complications and death. Chronic obstructive pulmonary disease patients who do not take prescribed medications face a 58 percent greater risk of hospitalization and a 40 percent greater risk of death. An estimated 89,000 people with high blood pressure die prematurely every year just because they do not take their medications. Various estimates suggest that the failure of Americans to take their medicine costs the nation anywhere from $100 billion to $300 billion every year.

At first glance, it seems this should be an easy problem to solve. But it isn’t. Humans are complex creatures with many competing motivations, inhibitions and inspirations. Over the years, my colleagues and I have tested several strategies to improve patients’ adherence to treatment, most recently sending text messages to teens and automated reminder calls to adults. These are small steps that have yet to make a significant dent in the overall problem.

I do believe, however, there is a solution. The nation’s successful effort to reduce smoking can be an inspiration and a model for successful behavior change on a large scale. With a sustained and multi-faceted national effort we have succeeded in cutting tobacco use in half over the past four decades.

First, we need broader recognition that non adherence to treatment is a public health problem, not just an issue between patient and doctor. It needs to be an integral par t of the health care debate and the subject of a broad public awareness campaign. Second, everyone must get involved, not just physicians and other care providers. Health care providers, insurance companies, government, and employers all must work together to improve access to medications, educate patients about the importance of taking medications, motivate them, and help them manage and remember to take their medications. By first recognizing the opportunity, then working together to seize it, we can improve the nation’s health and save lives, while reducing health care costs.