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A Proven Healthcare Cost Containment Solution
The CUHSM Patient Adherence System

CUHSM.ORG is committed to helping our nation achieve better and affordable care, and improving the overall health of Americans. 
 

It is thought that between a third and a half of all medicines prescribed for long term conditions are not taken as recommended. If the prescription is appropriate, then this may represent a loss to patients, the healthcare system and society. The costs are both personal and economic. Adherence presumes an agreement between prescriber and patient about the prescriber's recommendations.

Adherence to medicines is defined as the extent to which the patient's action matches the agreed recommendations. Non-adherence may limit the benefits of medicines, resulting in lack of improvement, or deterioration, in health. The economic costs are not limited to wasted medicines but also include the knock˗on costs arising from increased demands for healthcare if health deteriorates.
 

Non-adherence should not be seen as the patient's problem. It represents a fundamental limitation in the delivery of healthcare, often because of a failure to fully agree the prescription in the first place or to identify and provide the support that patients need later on.  Patient adherence has grown to epidemic proportions.

Choosing to include our patient adherence metrics coupled with our integrated CMS submission process saves your organization time, effort and resources.

Specifically, CUHSM.ORG analyzes the implementation issues and administers solutions for the Healthcare Delivery problem of Patient Adherence:
 

The CUHSM Patient Adherence System^TM includes a patient evaluation of all events that happen to patients from the time they make an appointment to when an appointment is over and follow-up services are completed.

All aspects of the patient interview are evaluated, with special attention to customer service process interval analysis that is universally used by large retail organizations.

National research shows that patients having timely, positive experiences with the entire staff of their health care provider are more likely to adhere to regimens, schedule follow-up visits, seek preventive care, be less litigious, and be more active and engaged in managing their health.

Using suitable measures, patient adherence can be quantified in order to initiate follow-up targeted communications and adjust appropriate risk factors that correlate with patient interactions:

- HRA (Health Risk Assessments)
- Quality Measure Improvement processes & benchmarks
- Efficient Provider staff feedback
          CUHSM Adherence Dashboard improves care
         Extent & frequency of patient communications
           Smartphone technology integration saves time

Prioritized communications are used to gently remind patients of their regimen while conserving provider resources: 

- Interactive Voice Services
- Enrollment & welcome calls
- Disease specific coaching & surveys
 

  1. Schedule
  2. Language
  3. Scripting
  4. Coaching
  5. Process

 

  Patients prefer our selectable preferences

The CUHSM Patient Adherence System^TM  improves compliance by integrating user preferences such as:

- Multiple Language Support

- ADA compliance
- Personalized scripting

- Custom caller ID/Smart dialing solutions

- Variable call scheduling

Communicating with clients according to their needs and abilities improves adherence!

To help a busy practice with follow-up communications, the CUHSM Patient Adherence System^TM leverages multiple processes that align with your organizational goals:

- HME / DME Support
- Lowered cost
- Improved Provider and Patient satisfaction

Examples of Patient Adherence methodologies for specialties:

    FAMILY PRACTICE -          Reasons for Nonadherence to Medications

(HealthDay News) — Eight reasons associated with patient's intentional nonadherence to medications have been identified in a report published by the American Medical Association (AMA).

Noting that data show about one-quarter of new prescriptions are never filled, and that about 50 percent of the time patients do not take their medications, the report discusses reasons for intentional nonadherence.

According to the report, fear of potential side effects is one main reason for intentional nonadherence. In addition, cost may affect whether patients fill their prescriptions or ration their medication supply. Misunderstanding the need for medication, the nature of side effects, and the time taken to see results also affects nonadherence. Other factors that impact nonadherence include having too many medications, lack of symptoms, concerns about becoming dependent on medications, and depression. Mistrust of the doctor's motivations behind prescription of certain medications also influences nonadherence.

"A free online module can help you address these reasons and improve medication adherence in your practice," according to the article. "The module, part of the AMA's STEPS Forward collection, includes practical strategies and tools that you can immediately implement with your practice team."

8 reasons patients don't take their medications

Medication nonadherence—when patients don’t take their medications as prescribed—is unfortunately fairly common, especially among patients with chronic disease. Learn eight reasons why patients don’t take their medications and ways your team can help identify and improve patients’ adherence to their medications.

Patients can be reluctant to tell you that they don’t take their medicines. If you don’t have a true picture of a patient’s medication-taking behavior, you may needlessly escalate his or her treatment, resulting in potential harm to the patient, unnecessary work for the practice and increased costs overall.

Data show about one-quarter of new prescriptions are never filled, and patients do not take their medications about 50 percent of the time. Most nonadherence is intentional—patients make a rational decision not to take their medicine based on their knowledge, experience and beliefs. The top eight reasons for intentional nonadherence are:

• Fear. Patients may be frightened of potential side effects. They may have witnessed side effects experienced by someone else who was taking the same or a similar medication and believe the medication caused the problems.
• Cost. Patients may not fill medications in the first place or ration what they do fill to extend their supply.
• Misunderstanding. Patients may not understand the need for the medicine, the nature of the side effects or the time it will take to see results. This is particularly true for patients with chronic illness, because taking a medication every day to reduce the risk of something bad happening can be confusing. Failure to see immediate improvement may lead to premature discontinuation.
• Too many medications. The greater the number of different medicines prescribed and the higher the dosing frequency, the more likely a patient is to be nonadherent.
• Lack of symptoms. Patients who don’t feel any differently when they start or stop their medicine might see no reason to take it.
• Worry. Concerns about becoming dependent on a medicine also lead to nonadherence.
• Depression. Patients who are depressed are less likely to take their medications as prescribed.
• Mistrust. Patients may be suspicious of their doctor’s motives for prescribing certain medications because of recent news coverage of marketing efforts by pharmaceutical companies influencing physician prescribing patterns.

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CardioVascular:
Reasons for adherence with antihypertensive medication

Reasons patients give for not following regimen

1. Another solution found Unacceptable side effects

2. Mental health affects adherence (Alzheimers)

3.  Overly Complicated regimen (multi date multi-dosage, multiple meds)

4. Multiple regimens (each specialist has own regimen)

5. Prior Medical Error (self or friend or relative)

6. Negative or Lack of support from family/friends

7. Lack of education by provider  or support staff

9   Nonadherence was an active decision, misunderstandings of the condition ,General disapproval ,medication, facilitate daily life or, minimize adverse effects. Non-Adherent patients gave less evidence of involvement.

Background: Hypertension is often insufficiently controlled in clinical practice, a prominent reason for this being poor patient adherence with therapy. Little is known about the underlying reasons for poor adherence. We set out to investigate hypertensive patients’ self-reported reasons for adhering to or ignoring medical advice regarding antihypertensive medication. Methods: Qualitative analysis of semi-structured interviews with 33 hypertensive patients in a general-practice centre and a specialist hypertension unit in Southern Sweden. Blood-pressure measurements and laboratory measurements of antihypertensive medication were performed. Results: Nineteen out of 33 patients were classified as adherent. Adherence was a function of faith in the physician, fear of complications of hypertension, and a desire to control blood pressure. Non-adherence was an active decision, partly based on misunderstandings of the condition and general disapproval of medication, but mostly taken in order to facilitate daily life or minimize adverse effects. Adherent patients gave less evidence of involvement in care than non-adherent patients. There was no obvious relation between reported adherence, laboratory markers of adherence and blood-pressure levels. Conclusions: The interview is a powerful tool for ascertaining patients’ concepts and behaviour. To optimize treatment of hypertension, it is important to form a therapeutic alliance in which patients’ doubts and difficulties with therapy can be detected and addressed. For this, effective patient–physician communication is of vital importance.

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    Antiretroviral:  Reasons for HAART adherence

Median self-reported adherence was 95% (n = 178, range = 60-100%). The most frequent reasons for at least 'sometimes' missing a dose were eating a meal at the wrong time (38.2%), oversleeping (36.3%), forgetting (35.0%) and being in a social situation (30.5%).

Reasons for non-adherence to antiretroviral therapy: Patients' perspectives provide evidence of multiple causes

Abstract

The objective of the study was to define common reasons for non-adherence (NA) to highly active antiretroviral therapy (HAART) and the number of reasons reported by non-adherent individuals. A confidential questionnaire was administered to HIV-seropositive patients taking proteinase inhibitor based HAART. Median self-reported adherence was 95% (n = 178, range = 60-100%). The most frequent reasons for at least 'sometimes' missing a dose were eating a meal at the wrong time (38.2%), oversleeping (36.3%), forgetting (35.0%) and being in a social situation (30.5%). The mean number of reasons occurring at least 'sometimes' was 3.2; 20% of patients gave six or more reasons; those reporting the lowest adherence reported a significantly greater numbers of reasons (p = - 0.59; p < 0.001). Three factors were derived from the data by principal component analysis reflecting 'negative experiences of HAART', 'having a low priority for taking medication' and 'unintentionally missing doses', accounting for 53.8% of the variance. On multivariate analysis only the latter two factors were significantly related to NA (odds ratios 0.845 and 0.849, respectively). There was a wide spectrum of reasons for NA in our population. The number of reasons in an individual increased as adherence became less. A variety of modalities individualized for each patient are required to support patients with the lowest adherence.

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MENTAL HEALTH SPECIALTIES:
Adherence to Lithium Prophylaxis: I. Clinical Predictors and Patient's Reasons for Nonadherence

Abstract

Of a group of 133 patients given long-term prophylactic lithium treatment, approximately 25 percent discontinued the treatment prematurely within the first six months. Young male patients dominated in the nonadherent group. Clinically the nonadherent patients were characterized by having had an early onset of the illness, a large number of previous hospital admissions and a recent allocation to the diagnostic category of affective disorder. Furthermore, the presence of personality disorders and substance abuses characterized the nonadherent patients. Diagnostic grouping according to polarity did not allow for any distinction between the adherent and nonadherent patients. One half of the nonadherent patients mentioned the development of somatic side effects as their main reason for discontinuing the treatment. Psychological discomfort, such as development of concentration difficulties or impaired memory, was not stated as a reasons for discontinuation. One fourth of the nonadherent patients had their diagnoses, and consequently their treatment, changed by the physician in charge and one fourth neglected instructions and disregarded appointments.

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   Why don't patients take their medicine? Reasons and solutions in psychiatry

Abstract

Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This article reviews the literature on non-adherence, whether intentional or not, and discusses patients' reasons for failure to concord with medical advice, and predictors of and solutions to the problem of non-adherence.

To research how Patient Experience websites can be designed to
     satisfy the requirements for all involved parties,
        please email us re: Patient Experience Research
. 

CUHSM QCDR Measures approved by CMS - Non QPP Program - Patient Adherence Measures
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Last modified: Tuesday November 10, 2020.