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The Dangers of Patient Medication Non-Adherence & Compliance

Posted by: Tim Brown on 4/21/21 9:30 AM

Are Behavior-Friendly Drug Delivery Systems a Solution?

“I forgot to take my meds.” You don’t have to be a healthcare provider to be familiar with the phrase. In fact, most of us have been there at some point.

You’ve missed taking your prescribed medication and now you’re struggling to remember to take the dosage at the next convenient opportunity, when you get a beverage to help swallow a pill, or get a private moment to take the medication. Too often in our busy, distracted world, the opportunity doesn’t present itself or we simply choose to not take it.

Why do we behave this way, when we know it’s not the best choice for our health? This is the question researchers studying human adherence behavior have been working to answer since the 1970’s. The quest for improvement in patient compliance behaviors has been diligently examined and followed for decades—because the consequence of non-compliance can be drastic for patients. Failure to comply with medication is known to increase hospitalizations, nursing home admissions, office visits, and contributes to poor clinical health outcomes and even premature death. THe saying goes, "the most expensive medication is the one never taken by the patient."

Supporting Patient Compliance

In healthcare, the most commonly used definition of compliance is the patient’s behaviors, like taking medication, following diets, or executing lifestyle changes that coincide with healthcare providers’ recommendations for good health and medical advice. For decades, therapeutic compliance has been a subject of continued clinical concern. As far back as 1996, in a US study, found that medication compliance averaged 49%, and worse, only 23% of the patients had what are generally accepted “good compliance levels” of 80% or higher. In spite of awareness of the issue, 25 years later, we’re not getting much better at raising compliance.

The Costs of Non-Compliance

Non-adherence to prescriptions is a top medical risk factor and contributes to poor health outcomes, including early death.

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In the clinical setting, forgetting or avoidance in taking medication continues to be a top-of-the-chart concern for most healthcare providers.

The medication works, we know that, now, if we can just get them to take it, is the mantra of the general practitioner and there’s no question that medication adherence is a major impetus to intended healthcare treatment results.

Humans in general, particularly in today’s stressful environment, avoid inconvenience and change. Modifications to a patient’s established behaviors, even temporary alterations to a medication schedule or daily routine, including the incorporation of a new medication are often met with patient resistance.

In fact, Mayo Clinic tells us that  even though 70% of us are taking at least one prescription and more than half of us take two, a full 30% of prescriptions are never even filled by the patient and another 50% are not taken as prescribed.  According to CVS, nearly 50% of people with a prescription for a chronic condition like cardiovascular disease stop taking it within the first year.

Modern compliance conditions have improved, but not enough. The goal of prescribed medical therapy is above all, to achieve intended outcomes in patient health and reduce the financial burden on the healthcare system. Most early death in the U.S. is related to chronic health issues that are heavily influenced by patient behavior, particularly compliance with and adherence to medical recommendations.

Recent estimates tell us that among hypertensive patients, 89,000 premature deaths could be avoided each year with improved patient compliance behaviors.

Healthcare and even non-healthcare organizations feel the sting of those numbers and of patient avoidance with non-compliance and non-adherence. Adherence is above all, intended to improve general health and statistics show an effective solution to non-compliance indeed contributes to well-being.

In the employment sector, a recent large-scale study found that adherence to medical advice, including prescriptions, improves employee productivity by $18,000 annually. The benefits to all are real and so are the costs. In fact, Walgreens’ research found that every 1% improvement in adherence saves about $50 in healthcare spending.

As a result of the decades of clinical experience and research, improved, strategic efforts on the part of the healthcare professionals and drug manufacturers continue to work to reduce non-adherence. We need to do better. Patient medication non-compliance still currently falls between 40% and 50%. 

Overcoming Behavioral Barriers

The ongoing struggle to get the patient to follow the doctor's orders also demands continued patient behavioral-focused research as well as the development of new strategies to improve patient medication compliance resistance.

For most medical conditions, correct diagnosis and effective medical treatment are essential to a patient's good health and quality of life. Social determinants of medication compliance include the management of significant barriers to effective administration of the treatments.

According to the CDC, social determinants of health (SDOH), are the conditions of everyday life that impact physical and emotional well-being by influencing patients’ likelihood of developing certain conditions and their ability to effectively manage them. Where people are born, grow, live, work, and age, in fact, makes more of an impact on outcomes than the medical care.

 ­The United States has reached a place where 145 million Americans have chronic diseases, and patients who are prescribed multiple medications represent a large and growing proportion of the population. Managing multiple medications and promoting patient compliance to those drug regimens is essential and it is challenging, especially in the increasing elderly population, whose comorbidities and cognitive impairments lead to a larger non-compliant population than younger adult patients.

Past and current modalities for improvement in adherence include delivering clear patient instructions in user-friendly language, working with the patient's' current and familiar daily routines, encouraging patient healthcare education and participation, and providing additional support to promote improved health.

Increased Medication Compliance Through Medication Delivery Choices

Could improvements in patient medication compliance be on the tip of our tongues? Turns out, they are.

Advancements in drug delivery systems have created additional patient behavioral friendly medication compliance opportunities for medication adherence. The statistics prove that patient ease-of-use in administration of their meds can be the solution, and is necessary for the safe and effective delivery of medications.

Tapemark, a full-service CDMO, understands drug delivery systems and knows that a flexible mindset and access to opportunities for improved drug delivery options is a clear advantage in patient compliance and ultimately, product usage and productivity.

Both oral film that can be easily administered without access to water, and transdermal patch drug systems manufactured by Tapemark are developed with a complete Pharmaceutical Quality System (PQS) and a focused, experienced, management team, whose primary objectives are ensuring the quality and efficacy of the medicinal product, patient safety, and improving non-adherence issues in the pharmaceutical industry.

Advantages that Don't Dissolve

Oral thin film is a preferred route of drug administration and is an increasingly popular choice for drug manufacturers. Patients appreciate the convenience and ease of taking medication using oral thin film, anywhere, anytime, leading to high levels of patient compliance.

Self-administration is made easier with oral thin film. Waterless delivery is convenient and chewing capability barriers are removed. Mobility deficits that lead to non-compliance, can be eliminated for the patient.

Oral thin film has additional advantages. When administering medication via oral thin film, the drug is directly absorbed into systemic circulation. This prevents degradation of the product in gastrointestinal tract and consequently first pass effect, which is the mechanism in which a drug gets metabolized at a specific location in the body that results in a reduced concentration of the active drug upon reaching its intended site of action, or into the systemic circulation. Oral film delivery prevents this reduction in efficacy of administered medications

Patient Customization

Oral films are increasingly popular for pediatric, neurologic, and geriatric patients. Dysphagic patients suffering from Parkinson's disease, mucositis, and other swallowing aspiration risks, can also benefit from oral thin film delivery. Swallowing issues are being increasingly recognized as a growing health condition throughout healthcare professionals when administering SODF or Solid Oral Drug Formulas.

There is agreement among medical professionals that the size, shape, color, taste, and mouthfeel have a significant impact on drug product swallowability and acceptance. Studies show that in order to achieve good compliance, as well as effective, safe, and independent pharmacotherapy, it is important for physicians and pharmaceutical professionals to be informed and address potential problems related to dysphagia, in order to prescribe/dispense suitable drug formulations and/or designs that can better meet the specific needs of each patient.

Fast dissolving oral strips are now familiar to most people. This newer drug delivery systems have gained a lot of popularity and acceptance with increased consumer choice, for convenience, portability and self-administration even without water or chewing. Many consumers have already experienced oral thin film in over-the-counter supplements and oral care products.

Adherence with Patient in Mind

The drive toward patient convenience and compliance-oriented research has resulted in the development of Tapemark’s cutting-edge patient friendly and safer drug delivery systems.

Tapemark’s transdermal patch is another alternative to SODF. The transdermal patch is a medicated adhesive system that is placed on the skin and delivers a specific dose of medication through dermal transmission and into the bloodstream.

This type of delivery system is effective in promoting direct delivery and healing to an injured area of the body. Another advantage of a transdermal drug delivery over other types of medication delivery such as topical, intravenous, or intramuscular is that the patch allows for a controlled release of the medication to the patient, usually through either a porous membrane covering a reservoir of medication or through body heat melting thin layers of medication embedded in the adhesive.

The main disadvantage to transdermal delivery systems stems from the fact that the skin is a very effective barrier; as a result, only medications whose molecules are small enough to penetrate the skin can be delivered in this method.

Partnering with Tapemark 

Tapemark builds relationships that stick and welcomes partnerships that foster greater patient satisfaction, improved patient adherence and therapies, and ultimately optimal healthcare outcomes.

With decades of experience and “the patient comes first” philosophy in both drug administration and product compliance development, Tapemark works to solve ease-of use challenges that face patients and manufacturers.

Tapemark’s expertise in every area of formulations includes packaging solutions and education to improve low health literacy that contributes to non-compliance. Fear of proper dosing in the elderly is a common issue “Did I take the medication?” concerns in the elderly can be abated with timed release patch delivery system.

Tapemark has developed sound solutions to overcome low health literacy that contributes to medication non-adherence. When patients don’t understand, they avoid. Our information solutions include examples of how to take a medication, when to take a medication, how much of a medication to take in easy to follow, anywhere instructions.

This more complete knowledge increases the effectiveness of adherence interventions and has a great impact on the health of the population with specific medical treatments.

As the scale and scope of drug administration improvements grow, so will the number of non-compliant patients, and thus the gains achieved by providers and their organizations by addressing drug delivery systems with Tapemark as a CDMO partner paves the way to improved patient compliance and care.

Even small improvements can positively impact many patients' lives while reducing expenses and improving productivity. Pharmaceutical manufacturers who partner with Tapemark benefit from the alternative advanced drug delivery capabilities, specifically developed to address patient ease of use issues, like oral film and transdermal patch manufacturing and design. These programs, targeted at the specific patients who need them, improve outcomes and keeps people healthier and safer.


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Tim Brown