Take 18 Pills & Call the Nurse in the Morning

In this issue, we highlight a critical problem in the care of patients with cardiovascular diseases and an approach for managing these patients or possibly even preventing diseases in the first place. The problem: Despite proven benefits of medical therapies, many patients fail to take their pills as prescribed. At the other end of the equation, nurses are beginning to take leadership roles in coordinated-care programs that increasingly show improved outcomes.

Medication nonadherence is common and costly. The World Health Organization estimates that about half of patients with chronic diseases in developed countries are nonadherent. In the U.S., the annual cost of medication-related hospital admissions due to poor adherence has been pegged at $100 billion—and that may be a conservative estimate (N Engl J Med 2005;353:487-497).

Many interventions exist to improve adherence, but their benefit hinges on both effectiveness and cost savings. It is not always clear that improvements in adherence translate to better outcomes, nor is it a given that the cost of the intervention will be offset by reductions in healthcare spending. Nor can any single intervention address the myriad obstacles that trip up compliance such as multidose regimens, high pharmaceutical costs and cognitive deficits in these patients, many of whom have multiple health problems.

Kathleen M. McCauley, PhD, RN, of the University of Pennsylvania School of Nursing in Philadelphia, points out that comorbidities are common among patients with heart failure. Nurses may become the patients’ “go-to” guys or gals to coordinate their care among various specialists. “For these patients, it’s most effective when nurses coordinate care,” she says. “You need someone to connect the dots of the patient’s varied health problems.” 

Nurses may be at the vanguard of not only the coordinated-care models described in this issue but also for some of the interventions designed to improve medication adherence. To counter the headwinds in nonadherence, we will need healthcare professionals working together as a team on the common goal of improving patient outcomes.