Who Will Lead Initiatives to Improve Adherence?

By | September 26, 2013

To improve adherence will require healthcare organizations to change the way they work. Such a change may be slow to occur, or may be stalled, when individuals don’t adopt the behavioral shifts needed to make the new approach successful.

How important is the role of leadership in making such healthcare changes happen? A recent study suggests the answer is “very important”!

Behavioral change is critical to improve adherence to medications.

Importance of Change Leadership

The study explored how three factors affected physicians support for a major change within a large healthcare organization. The new approach required changes to the nature of the interactions between patients and their physicians. The three factors were:

  • Team members’ agreement with the new approach
  • Team leadership and their support for the change
  • Team members’ readiness to adopt change

The authors concluded that leadership plays a major role. Indeed, in most situations where a significant change to everyday practices is undertaken, the strength of leadership will have a significant impact on its success or failure.

In this study, the team leaders were physicians. To improve adherence however, who will be the leaders? Who drive adoption of new practices and help ensure these practices are effectively implemented? Who will set examples that will influence others to follow?

Setting examples has strong leadership influence on others.

Leadership of Initiatives to Improve Adherence

Non-adherence to prescribed medication affects many aspects of healthcare systems. However, the fragmented nature of U.S. healthcare complicates the leadership question. For example healthcare professionals within the same system or institution may serve different masters.

At the moment, there’s no immediate, clear-cut answer to the question of who will drive initiatives to improve adherence. At first pass, four groups stand out as candidates for the role – either individually or collectively:

  1. Physicians are trusted by patients. They have regular contact with patients treated for chronic illnesses and have responsibility for appropriateness and quality of care. Expected treatment outcomes can only occur when medications are taken as instructed. So physicians should have a strong vested interest in improving adherence.
  2. Pharmacists also have regular contact with many patients and are a trusted source of advice. They have a clear role in assessing a patient’s medication management; to ensure safe and effective use. Assessment of adherence can readily be a part of this assessment. Pharmacists’ role in promoting medication adherence is strongly advocated by professional pharmacy bodies.
  3. Payers and Provider Groups both have leadership roles in ensuring that physicians and pharmacists are appropriately incentivized to address medication adherence challenges. Evidence for the relationships between improved adherence, reduced healthcare use, and better outcomes is strong. By investing a portion of projected savings to motivate physicians to more actively address the topic, medication adherence can be significantly improved.
  4. Government has a leadership role on adherence too. Around 40% of National Health Consumption Expenditure costs are accounted for by Medicare or Medicaid, so it has direct interests in improving adherence. For 2013, five of the 18 individual measures in the Part D CMS star rating process are related to adherence; with 3%-to-5% ‘quality bonus payments’ paid to participating provider groups aligned with star ratings received (3-to-5).

Who Should Lead Adherence Changes?

Who, in your opinion, should step up and take leadership roles to improve adherence to medications?

If, as seems likely, system-wide solutions to improve adherence will need combined efforts between all these players; then what’s the forum that gets all these parties on the same page?

What are your thoughts on these questions?