On last week’s program, Tom Hubbard, Senior Program Director at NEHI, a national health policy institute and think tank, based in Cambridge, Massachusetts, spoke about some of the practical ways to reform our health care system. This week, we continue the discussion, focusing on how poorly some patients use their medications and what can be done to improve medication use. Improving adherence to treatment is critical because it would improve outcomes and lower costs but there is no one solution. Research shows that patients are non-adherent for lots of reasons. Their total list of medications may not be right, doses may not be right, and review by a physician and/or pharmacist could help. Other barriers include side effects, complicated dosing, and very personal factors, such as costs, beliefs about medication effects, and cultural factors. Strategies to improve adherence will need to be customized to patients’ specific needs. Doctors, insurers and drug companies may all play a role.

One key to improving outcomes may be to tie payment to successful treatment, putting more at stake for physicians. This is a contentious and exciting time in medicine!