Reimbursed medication adherence enhancing interventions in 12 european countries: Current state of the art and future challenges

Abstract

Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries.Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase.Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors (n = 6), nurses (n = 6), or pharmacists (n = 3). The most common types of MAEIs were education (n = 6), medication regimen management (n = 5), and adherence monitoring feedback (n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e., implementation and persistence.Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement.

Anticipated barriers and facilitators for implementing smart inhalers in asthma medication adherence management

“…For example, policy makers require evidence on the added value of smart inhalers to enable reimbursement, HCPs want to be compensated for their time invested and patients want to pay as little as possible. A complicating factor regarding reimbursement decisions is that eHealth use by HCPs is difficult to quantify and therefore does not easily fit in the current reimbursement system in healthcare 46 , 47 . A second complicating factor is the perspective regarding alternatives to smart inhalers.…”

Implementation of digital home monitoring and management of respiratory disease

“…As evidence accumulates of effectiveness of disease or task-specific digital interventions on clinical outcomes and/or organizational efficiency [ 10 ▪ , 13 – 18 , 19 ▪ , 20 ], the focus is shifting to broader strategies that could promote implementation as a sustainable approach to delivering respiratory care [ 21 ]. However, successful implementation is complex requiring understanding of the patient, professional and organizational perspectives [ 22 ], as well as developing the technology infrastructure [ 23 ], working within the political, economic and regulatory policy context [ 24 ▪ ], and addressing societal concerns about health literacy, exacerbating digital inequalities [ 25 ], the impact of remote care on patient/professional communication [ 26 ], engendering trust and ensuring data security.…”

“…For example, a novel smart inhaler with an established pharmacologic compound might be judged – and priced – as a generic alternative ignoring the added value of the digital component (e.g. a usage monitor and connected app supporting adherence) [ 24 ▪ ].…”

Half a Century of Fragmented Research on Deviations from Advised Therapies: Is This a Good Time to Call for Multidisciplinary Medication Adherence Research Centres of Excellence?

“…The Polish team took an active part in this cooperation, organising the first physical ENABLE Working Group meeting in Lodz, Poland, on 16–17 September 2021. Moreover, MARC initiated two important studies within the framework of ENABLE, i.e., TherapyMaintenance@Covid, which assessed the medication management practices in place for chronic diseases during the COVID-19 pandemic across European countries [ 6 , 7 ], and the EUREcA study which identified reimbursed medication adherence enhancing interventions currently available in Europe [ 13 , 14 ].…”

“…In particular, reimbursement decisions related to these interventions require high-quality evidence of their effectiveness and cost-effectiveness, which is currently lacking quite often. In consequence, the number of adherence-enhancing interventions reimbursed in Europe is still very low [ 13 , 14 ].…”