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Improving Adherence Can Reduce Complications and Healthcare Spending

August 23, 2016
Posted by: Jamie Zacher, PharmD

According to a report published by the IMS Institute for Healthcare Informatics in July, the cost of treating those with type 2 diabetes was $176 billion in 2012, with diabetes-related complications accounting for around 61% of the cost(1). These complications, such as vision problems, kidney issues, cardiovascular disease, nerve damage, and toe and foot amputations, occur when blood glucose levels remain elevated and untreated. As complications worsen, costs increase. The reports states that, although complications can often be reduced with proper adherence to medication therapy to reduce blood glucose levels, many patients do not take their medications as prescribed, if they even take them at all (2). The report concludes that increasing adherence and decreasing complications will not only reduce the number diabetes-related deaths but also save billions of dollars each year spent on care. (3). It offers several recommendations to increase medication adherence and reduce complications and health care spending for patients with type 2 diabetes.

IMS recommends effective patient activation. Patient activation is defined as “how well a person understands his or her role in the care process and, whether that person has the knowledge, skills, capacity, and confidence to follow through with this role.”(4). Each patient must not only be able to understand how to manage their own health care but also have the ability and desire to do so. Research has shown that increasing patient activation can lead to an increase in adherence and a reduction in health care spending (5). There are three key phases to achieving ultimate patient activation and optimal adherence: identify and profile, activate, and sustain (6).

First, the identify and profile phase is used to assess a patient’s current level of activation and evaluate their attitude, behaviors, motivations, and challenges to determine how they arrived at their current level of activation (7). This phase can identify high-risk patients who may need more education and support to increase medication adherence. Pharmacists have contact with patients on a regular basis and can help identify patients who may not understand why they need to take their medication, how to take their medication, and those who cannot afford their medication. Pharmacists can then work with the prescriber to fill in educational holes or find less expensive therapeutic alternatives.

Next, the activate phase is used to take what patients learned in the first phase to create interventions, set goals, and create action steps to improve adherence and reach optimal patient activation (8). Each patient should have their own individual education and goals set up specifically for them. Physicians, nurses, and pharmacists can use motivational interviewing and the teach-back method to ensure that patients are retaining the education provided to them and that they know what needs to be done to reach their therapeutic goals. This phase should be a team effort in which all health care providers contribute to help patients improve adherence and reach optimal activation.

Finally, once a patient has reached a high degree of patient activation, the patient will enter the sustain phase in which he or she can better self-manage the therapy and maintain a high degree of adherence (9). Healthcare providers will have a lesser role in this phase because they have already taught the patient how to manage their disease and how to take their medication. Healthcare providers can, however, still provide positive reinforcement and encourage the patient to remain actively involved in their health care. Pharmacists can play a large role in this sustain phase by occasionally contacting the patient to verify that the patient is still taking their medication correctly and to answer questions.

Although the IMS report focuses on type 2 diabetes and improving adherence to decrease complications and health care spending, the same principles can be applied to any disease state and any practice area, including clinical research. Greater patient activation can lead to increased medication adherence, decreased complications, and decreased health care spending.


1,2,3,4,5,6,7,8,9. Aitken, M., et al. Improving Type 2 Diabetes Therapy Adherence and Persistence in the United States. IMS Institute for Healthcare Informatics. July 2016.

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