Little Rock, AR - The Case Management Society of America (CMSA) today introduced CMAG-1, its Case Management Adherence Guidelines for improving patient adherence to medication therapies. The guidelines were created over the past year in hopes of helping patients work with their health care providers to overcome the current epidemic of non-adherence, which studies show costs some 125,000 lives a year to cardiovascular disease alone, plus a $100 billion burden to the health care system.

"Only about half of patients in the U.S. take their medications as prescribed, which decreases both the quality of their lives and life spans and correspondingly increases healthcare costs," said Sherry Aliotta, president of CMSA. "Numerous studies show the benefits of using medicines to improve clinical outcomes and prevent hospitalization. It’s an educational and motivational challenge to overcome this epidemic, but results can be significant. Every 1 percent increase in adherence could translate into a $1 billion savings for our health care system and better lives for patients with chronic conditions."

The guidelines were released last week during the organization’s annual conference in Nashville, attended by more than 2,100 case managers. Case management -- a collaborative process of assessment, planning, facilitation and advocacy -- helps individuals reach their optimum level of wellness and functional capability in a cost-effective and timely manner. CMSA is the profession’s largest organization.

Aliotta said non-adherence has become a growing challenge. Studies by the American Heart Association highlighted the negative impact of non-adherence on cardiovascular patients. Initially, 12 percent fail to fill their prescriptions. Another 12 percent fill the prescription but don’t take the medications. Then, 29 percent stop taking their medications before completing their course of therapy.

"Non-adherence with cardiovascular medications alone causes more than 125,000 deaths in the U.S. each year," said Aliotta. "This is alarming. Non-adherence ranks as the fourth leading cause of mortality after heart disease, cancer and stroke."

Additional studies show that 10 percent of all hospital admissions and 23 to 40 percent of all nursing home admissions are the result of non-adherence. According to CMSA, studies show patients with HIV infection are at particular risk for non-adherence: 95 percent adherence achieves an 80 percent probability of sustained viral suppression; adherence below 95 percent drops suppression to 50 percent.

Non-adherence is the most powerful predictor of a relapse in patients with schizophrenia, CMAG-1 reported. In a retrospective analysis of 48,000 patients with schizophrenia who were treated at a Veterans Affairs medical center, non-adherent patients had a 2.4-fold increase in hospital admissions.

Aliotta said the problem is multi-faceted and complex. As a result, no single approach can be successful in improving adherence. This led to development of the new guidelines.

The two barriers to adherence are motivation and knowledge. CMAG-1 provides several tools case managers and health care professionals can use to identify patient motivation and knowledge deficiencies that may be barriers to adherence. Then, the guidelines provide tools and techniques to minimize or remove barriers to taking medications appropriately.

"Medication adherence is very important in my clinical practice, which focuses on chronically ill and the elderly," according to Patricia Bomba, M.D., Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield, Rochester, NY. "With chronic illness, patients find it more difficult to stay on a medication regimen. Add in problems of the aging and the issues get more complex. Think about an older person with complex diabetes and cognitive impairment who is living alone. He or she needs an advocate and the primary care physician needs a member of the team to help support the care plan in between visits."

Bomba, a member of the physician’s advisory panel for CMSA, said studies cited in the guidelines show the importance of case management in caring for complicated patients.

"The approach improves their outcomes while decreasing health care utilization," said Bomba. "With the aging of the population, it will be even more important to educate and motivate patients who have just started developing chronic illnesses. I’ve been in practice 25 years, and the more we do in the early stages in terms of prevention, the better the results."

H. Richard Adams, M.D., Rehabilitation Associates Medical Group, Long Beach, Calif., a member of the CMSA physician's advisory panel, deals with catastrophic cases involving brain injuries in his practice and believes the new guidelines will be important.

"I receive referrals of patients that may have had fragmented care, such as individual approaches to rehabilitation, i.e., speech, physical, occupational therapy and adherence to a therapeutic regimen," said Adams. "I advocate for a case manager to be assigned to better coordinate all elements and better serve the needs of the patient. In my experience, this significantly improves outcomes. The new guidelines will further enhance the process to a more efficient and effective level than was achieved before."

Although CMAG-1 applies specifically to medications, the guidelines may be adopted to any situation where improved patient adherence is necessary to achieve therapeutic goals (exercise, weight reduction, smoking cessation, psychological therapy). It starts with an adherence management algorithm to assess knowledge and motivation, which enables the care provider to put each patient into an appropriate plan.

The guidelines include means of analyzing a patient’s social support network and proven concepts on motivational interviewing. CMAG-1 also covers factors that influence special patient populations, including the elderly, adolescents, substance abusers and racial and ethnic groups.

"CMSA is optimistic that these new guidelines will increase adherence to therapy, with positive clinical outcomes for patients and reduction in costs to the health care system," said Aliotta. "The guidelines provide the foundation. The ultimate results will depend upon how well our profession can educate the world about the epidemic and its ramifications, then facilitate change. CMAG-1 is one small but important solution to the rising cost of health care and we look forward to its continuing evolution."
###