The behavioral economic challenges of medication adherence

For physicians, identifying the proper medication to treat a patient may ultimately just be the first hurdle to clear towards their recovery. Human behavior plays a significant role in the way prescription drugs are assessed, discussed and selected. Whether it’s taking medication or receiving a Covid-19 vaccination, confirmation bias remains a barrier to overcome when patients overvalue information that aligns their perspective and aren’t open to accept contradictory information.

“We will be much more effective at improving health behavior if we work with the irrational parts of our nature … instead of ignoring them or fighting against them,” said David Asch, MD, MBA, executive director of the Penn Medicine Center for Health Care Innovation, according to the American Medical Association.  “When it comes to health care, understanding our irrationality is just another tool in our tool box. And harnessing that irrationality, that maybe the most rational move of all.”

Thus, physicians can adopt a behavioral economics approach to comprehend human behavior, and the biases and perceptions that become a factor for individuals when considering medical advice. This then provides physicians with the ability to frame their interactions and nudge their patients towards making decisions that will have a positive impact on their health and adhere to medication.

Medicine that is most suitable for a patient

Patients entering a physician’s office with their diagnosis, and preferred medication to treat their ailment already set in their mind is a challenging dynamic medical professionals face. Once the diagnosis is made, then the treatment discussion progresses. As the physician outlines the prescription and walks the patient through the benefits and any potential side effects associated with the drug, then its quality may come into question. Is this the generic version? Are there alternative drugs or treatments options? These are questions that frequently arise in a physician’s offices. “Communications often focus solely on sharing information to address a knowledge deficit, when in fact the need is to address a behavioral deficit,” Asch said, according to an article on Val Health.  If the patient lacks familiarity or hesitation with the drug, then this provides the opportunity for the physician to better address the individual’s perceptions and inclinations about the drug and build a dialogue that will lead to the patient’s behavioral change in their decision making about the medicine.

The financial implications of prescription drugs 

Americans spend on average $1,200 per person per year on prescription drugs. The socioeconomic status of an individual has the potential to impact an individual’s willingness to visit a physician, and then take the prescribed medicine. If an individual does not have health insurance, then the cost associated with out-of-pocket expenses is a major roadblock towards a visit with a physician and can lead an individual to bypass consulting their physician. However, if an uninsured individual does have the resources for the visit, then the cost to fill a prescription may still not be achievable. Further, it has been reported that 33% of patients have intentionally skipped filling a prescription because of its high price. While an insured patient may seek treatment, if they can’t afford it, then medication adherence decreases when their physician is unaware of the cost of the drug and prescribes medicine that their patient can’t afford to purchase.

The medication adherence commitment of patients

Physicians can prescribe and educate patients on drugs, but medication adherence is needed by the patient to follow the recommended treatment. Physicians can use an adherence estimator to identify patients who may be at risk for medication non-adherence. If physicians determine a patient may not keep up with their prescription, then additional communication can take place to influence a patient to remain committed to their treatment. While medicines enable patients to recover from an illness, 75% of prescriptions are not taken as directed, thus patients don’t gain the full benefits of it. In addition, complications arise with refilling prescriptions. With 25% of new prescriptions being written never filled, and 40% of those patients who fill their prescription not getting a second refill after six months, it becomes a daunting task for physicians to get the patient on track and committed to their recovery.

Colleen A. McHorney, an internationally recognized thought leader in the fields of health outcomes assessment and medication adherence, and former Senior Scientist at Merck’s U.S. Outcomes Research, told Pharmaceutical Executive magazine that, “I estimate from Merck’s research, as well as others, that only 20% of non-adherence is due to forgetfulness. The other 80% consists of people making intentional decisions about their medications. You can text people all they want and have sirens go off on their pill bottle caps, but unless the patient feels that they need a medication and they don’t have concerns about taking it, I don’t think technology is going to make the inroads its advocates claim.”

Reduce prescription barriers for patients

Physicians have barriers that they must overcome to diagnosis, prescribe and have their patient continue to follow their treatment, such as a patient’s lack of accessibility to obtain a prescription from a pharmacy, fear of side effects, misinformation about the benefits of the medication or the cost of the drug. Physicians can have a positive impact on the lives of their patients by gaining a stronger grasp of their circumstances and learn how to best address it with their patients. For instance, sharing details about the availability to access drugs via a patient assistance program to receive the medical care needed will open the opportunity for patients to adhere to their medication, if financial circumstances are the barrier a patient faces to obtain a prescription.

“A key principle of behavioral economics isn’t just recognizing that we are irrational — but that we are irrational in highly predictable ways. And to be effective, we need to know how to hitch our programs to those predictable psychological foibles,” stated Asch to AAMCNews.

In the United States, approximately 125,000 deaths per year are due to medication non-adherence, but with addressing these areas, physicians can better adapt to the behaviors of patients. As medical professionals take a behavioral economics path to comprehending the actions of patients, the more likely they can identify the tactics needed to have patients adhere to medicine. It’s essential for physicians to consider the circumstances of their patient’s life while communicating the treatment plan and engage them with dialogue that addresses any challenges or hesitations that they may have to achieve medication adherence.

Photo: Stas_V, Getty Images

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