Nonadherence in the Learning Healthcare System
Avoiding a Mountain by Seeing the Bumps
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- decision support systems, clinical
- health information systems
- medication adherence
- myocardial infarction
- secondary prevention
A Learning Healthcare System has been defined by the Institute of Medicine as a system in which continuous improvement and innovation occur and best practices are seamlessly embedded in the delivery process.1 New knowledge is captured as an integral by-product of the delivery experience. This framework seems directly relevant to the problem of medication nonadherence, which can occur at multiple points when a patient is on lifelong therapy and often goes undetected but, if recognized, can be addressed by therapeutic changes that address the underlying cause (eg, side effects). Statin medications can be used to illustrate how a Learning Healthcare System framework can be applied to the challenge of medication nonadherence.
See Article by Booth et al
Statins are among the most important medications for secondary prevention of acute myocardial infarction (AMI).2 In the 5 years after AMI, one need only treat ≈30 patients with a statin to prevent 1 cardiovascular death.3 Statins are overall well tolerated—despite occasional media coverage to the contrary—and their benefits seem to accumulate over time.4,5 As evidence for their clear efficacy has accumulated, prescriptions for statins after AMI have accelerated.6 Yet, up to 30% of patients are nonadherent with secondary prevention therapy just 6 months after a heart attack, a number that increases to 50% at 2 years7,8 and increases the risk of adverse outcomes.9 Interventions that increase healthcare intensity and access, such as electronic reminders and educational programs, may work10 but are infrequently used because additional resources are needed to capture at-risk patients.
Identifying nonadherent patients is hard: in most practices, it requires …