Fibromyalgia is a challenging condition to treat. Few of the available treatments are perfect solutions and some may cause side effects of their own. Some treatments may become more effective over time if patients keep taking them and get through the adjustment phase. But unfortunately, many people give up on medications or fail to take them consistently. Being noncompliant with medication use makes them less likely to be effective. A new tool may help doctors predict the risk of noncompliance among fibro patients. Read more about the details of the tool and why it matters.
The Rx-NAPT Tool
Researchers at the University of Florida analyzed the data from 6,626 patient claims on Medicaid in South Carolina. The researchers looked at the percentage of patients who didn’t comply with doctors’ instructions. From this data, they created a tool called the Prescription Medication Non-Adherence Prediction Tool (or Rx-NAPT, for short.)
The Rx-NAPT allows prescribers to evaluate a patient’s risk of noncompliance based on their individual circumstances. The retroactive study was published in the journal Pain Practice. The factors associated with greater noncompliance were the following:
- Fibromyalgia-related comorbidity score (presence of other illnesses in addition to fibro)
- Medication type
- Emergency room visit
- HMO coverage
The average non-adherence risk score on the Rx-NAPT was between 54 and 91, with 70 being about the average. Scores in that range predict greater noncompliance.
Why Noncompliance is So High
The biggest factor in many instances of medication noncompliance relates to financial factors. Fibromyalgia can be an expensive disease to have, especially for patients with low incomes. Studies have shown that direct healthcare costs are up to three times higher for fibro patients. Indirect costs, such as pain and reduced productivity at work, are twice as high.
Many patients bear these costs themselves. But many of the costs are also passed on to insurers and to society when patients are underinsured. About 34 percent of fibro patients spend between $100 and $1,000 per month to seek treatment, according to 2007 data. Changes in health insurance have passed on more of the cost burden for treatment to the patients. Not surprisingly, chronically ill patients often have more difficulty making these payments.
In addition, these costs are above those of insurance premiums. Because the nature of fibromyalgia can impact work productivity, fibro patients may face more economic pressures. The extra costs for fibro treatment are a significant factor in noncompliance. Patients sometimes have to forego treatment because of cost reasons.
Limits of the Rx-NAPT
Compliance is defined as adhering to the medication schedule prescribed by your doctor. The Rx-NAPT predicts the likelihood of adherence. A surprising 72.5 percent of patients in the study were not adhering to their doctors’ prescriptions. It makes sense that doctors would want to discover the possible risk factors for nonadherence.
At the same time, the Rx-NAPT has its own limits. Perhaps the most confounding result is that a third of patients who are adherent to their medications are still at high risk for noncompliance. Even patients who are currently compliant with their doctors can be at risk of ending their compliance at any time.
Creative Solutions to Increase Compliance
Increasing patient medication compliance requires several different strategies. One of the greatest risk factors is economic, and it is unlikely that the cost structure of healthcare will change any time soon. But many other factors can be overcome with some creative solutions.
One of the biggest modifiable factors is how the medical community interacts with patients. Most health plans still reach customers by sending printed materials in the mail. But patients tend to overlook items sent through the traditional snail mail. Promotional fliers often get thrown in the trash unread.
Reaching out to patients in alternate ways may increase compliance. Different strategies include connecting with patients include:
- Through e-mail
- By text messages
- Having personal phone calls to check in with patients
- Borrowing strategies from other industries, including online gaming and retail
But following up with patients more personally can provide opportunities to address issues that lead to noncompliance. Trained representatives can help patients who feel like their medication is ineffective. They can provide solutions for common medication side effects. They can also help patients find additional community resources.