Patient medication compliance refers to the degree to which a patient complies with instructions around drug regimens prescribed by the doctor. According to one World Health Organization study, up to 50% of patients have poor medication compliance rates.
This is problematic because medication adherence directly affects the effectiveness of treatments, not only affecting patient outcomes but also increasing healthcare service utilization and overall health-care costs. In this article we look at some of the reasons patients fail to comply with their medication regimens and how providing medications at the point of care can mitigate these challenges.
What is Physician Dispensing?
Physician dispensing (also known as point of care dispensing) is the process of giving patients their prescription drugs in the doctor’s office, as opposed to patients with their prescription in-office prescriptions by preparing and delivering prescription drugs to your patients when they are actually present in office. Technology, software, and medical suppliers assist in this process and ultimately allow the management of drug inventory, applicable dosing, and prescription dispensing. Delivering your patients medications via physician dispensing is safe, efficient, and cost-effective for your patients. And as we discuss in this article, it helps patients receive and utilize prescriptions in the manner intended. The World Health Organization identifies five factors that can lead to patient medication non-adherence.
The Five Dimensions of Patient Medication Non-Adherence
1. Patient-Related Factors
Patient related factors can be the most common among non-adherence to prescription medication. These factors include forgetfulness, inaccurate beliefs about medication, low health literacy, and failure to carefully read prescription labels. By having compliance conversations with patients as they are receiving the medication, you will be able to answer questions that patients may have, surface and defuse unstated issues or objections that the patient may have, and explain the necessity of medication adherence.
2. Social and Economic Factors
Social and economic factors that can lead to patient non-adherence include limited language proficiency, health literacy issues, unstable living conditions (e.g. homelessness), lack of health insurance, and medication cost. Some - though not all - of these factors can be addressed with in-office dispensing. For example, some generic medications can be purchased in bulk from physician dispensing companies and sold directly to patients for less than their insurance copay or cost at the pharmacy. Other issues can be recognized by a physician’s office more readily than at a pharmacy and appropriate education and planning steps can be taken.
3. Health Care System-Related Factors
As above, physicians are likely to know more about their patients than pharmacies, and can anticipate and plan around issues that might occur. For example, patients may take a prescription but not follow up by actually having it filled in a timely fashion. According to one study of 15,961 patients in a network of 131 physicians, prescription non-adherence was over 30% (31.3%), amounting to over 31,000 prescriptions which were written but not filled. By dispensing the patient’s medication to him or her directly, this problem is eliminated. In many cases, there are significant barriers to a patient getting his or her prescription filled at the pharmacy. The process can be time-consuming, especially if the pharmacy is not conveniently located, is busy, or takes time to prepare the medications in the correct doses. In some cases, privacy is also a concern; a physician’s office is generally more private than the local pharmacy, where neighbors might witness or overhear sensitive conversations about a patient’s health.
4. Condition-Related Factors
Condition-related factors refer to where the specifics of a patient’s medical state impact his or her compliance with prescriptions. For example, a patient might not adhere to medication instructions because of such factors as lack of symptoms, change in severity of symptoms, depression, or psychotic disorders. While physician dispensing is not a cure-all in this case, the ability to educate the patient in-office, armed with some knowledge of the patient’s overall health and situation, can anticipate and/or mitigate some of these issues. This is the case even if this knowledge of the patient is limited to what can be learned from one diagnostic appointment, as it will still likely be greater than the information available to a pharmacist if and when the patient arrives with a prescription to be filled out.
5. Therapy-Related Factors
Therapy-related factors include issues such as the patient not complying with the treatment program because of perceived complexity or long duration of the therapy or side effects (perceived or actual) of taking the drug. By reassuring your patient the value of adhering to the regimen (no matter how complex, long, or dynamic) and being able to respond to the patient’s issues in a holistic manner, relative to his or her overall treatment, a physician dispensing program can help improve adherence.
Conclusion: In-Office Medication Dispensing and Patient Medication Adherence
Physician dispensing can provide a number of possible benefits to the problem of patient prescription medication non-compliance. However, it is not a cure-all and many factors contributing to non-adherence cannot be solved by in-office dispensing alone. That said, by providing patients with the opportunity to receive their medication directly at the point of care, physician dispensing can be one of the building blocks to improved patient care and decreased health system costs.