Sally Greenberg, the executive director of the National Consumer League, was in Providence recently to promote her organization’s awareness campaign, Script Your Future, an effort to promote adherence to medication for chronic conditions such as asthma, high blood pressure and diabetes.
Providence was one of six cities chosen to participate in the consumer awareness campaign – for its high incidence of chronic diseases and because it was considered to have a strong health infrastructure.
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Providence Business News caught up with Greenberg at Olga’s Cup and Saucer, on her way to a local event to promote financial literacy for teens.
PBN: According to your campaign, lack of adherence to prescription drugs costs Americans about $290 billion a year in health care costs? How did you quantify that figure? What’s the source?
GREENBERG: The figure came from an organization, NEHI, [The National Network for Health Innovation] in Boston. The research indicated that the cost of non-adherence to the health care system is about $290 billion a year. They looked at what it costs to readmit someone to the hospital if they do not take their medication as prescribed. For instance, if a diabetic [not taking his or her medicine] goes back to the hospital, is readmitted through the emergency room, and is treated at the hospital for a number of days until stabilized, there is a high cost to that.
The costs are much higher for readmission for some of the chronic illnesses, such as cardiovascular disease, if they’re not taking their medicine.
PBN: We are in the midst of an epidemic of prescription painkillers abuse. More people are killed each year in Rhode Island from accidental overdose from such drugs than from car accidents. Is this the flip side to non-adherence?
GREENBERG: That’s an important issue, but this campaign is really about something different. This is about people with chronic disease who need to take their prescriptions as directed, or they are likely to land back in the hospital.
This is not about people abusing painkillers; it’s apples and oranges. We’re about safe use of medications. We’re about safe use of medications for people who need medications because they need them to stay healthy. We’re focused on three chronic conditions – diabetes, asthma and cardiovascular disease.
PBN: In Rhode Island, about 140,000 people are without health insurance – 14 percent of the market. Is the lack of health insurance – or the lack of money – a major factor in influencing nonadherence?
GREENBERG: Here’s what we found in our consumer surveys when we did focus groups. Money is one factor, but it’s not the only factor, nor is the most important reason why people don’t take their prescription drugs. We even found that with generic drugs, the adherence level falls off precipitously after one year, and that’s for drugs on the lower cost spectrum.
Now, having said that, if people do have serious problems in affording their medication, one of the things this campaign is intended to do is open the lines of communication [between patients and caregivers]. We want patients to know that they should be talking to their doctors, talking to their pharmacists, they should talking to their nurse practitioners about why they are not able to adhere to their medicine.
If money is a a significant factor, there are patient assistance programs. No one should be non-adherent because costs are standing in their way.
PBN: Is it a matter of changing behavior. Many chronic illnesses are linked to behaviors such as smoking, overeating, and a lack of exercise. How do you change people’s behavior patterns?
GREENBERG: This is an awareness campaign – and a health campaign as well. The Script Your Future website has a lot of information about healthier lifestyles that can be built into medication adherence.
Some people have chronic illnesses, not as a result of past behavior, but related to personal history. When we kicked off the campaign in Washington D.C., we had someone who spoke about his inherited heart disease. He was thin as a rail; he had to have a heart transplant. Heart disease ran in his family.
There has to be a behavioral component, we are stressing that. Sure, we would love to see people who did not need diabetes drugs because they were able to lose 30 or 40 pounds, bring their blood sugar levels down, and be healthier. But there is some proportion of people who have diabetes that has nothing to do with lifestyle choices.
We need to cover all the bases. We need to have people taking their medicine to prevent them from landing back in the hospital.
PBN: Why Providence?
GREENBERG: There were three factors we used to pick our six target cities. First, there had to be a significant proportion of people who had the three chronic diseases [we targeted]: diabetes, asthma and cardiovascular disease. Secondly, it needed to be a smaller media market, more affordable, to roll out the campaign. We don’t have the funds to go to New York City, Chicago, Los Angeles or Atlanta. We’d like to, but we don’t have the resources.
Thirdly, each of the target cities [Baltimore, Birmingham, Ala., Cincinnati, Raleigh, N.C., and Sacramento, Calif., and Providence] had to have a strong health care infrastructure with partners that we can rely on and work with.
