May 2011

Dear Medicine Communication Colleague:

In 2010, almost four billion prescriptions were filled in the U.S., totaling more than $307 billion.1 That’s the cost, but what about value? What is the value of medicines used appropriately, to keep a chronic condition in check, to promote healing, to ease pain, or to fight disease? For many patients, their loved ones and caregivers, that value can be priceless. However, achieving full value from one’s medicine is not always easy, nor straightforward.

This may be especially true for older adults: among those age 60 and older, more than one-quarter (27%) took 3-4 prescription drugs in the past month, while over one-third (36%) took five or more.2 As one’s total number of medicines, different prescribers, and different pharmacies used to fill prescriptions increases, one can inadvertently tilt the benefit/risk profiles of combined therapies to a dangerous level. Overall, the cost of drug-related morbidity and mortality was estimated at more than $177 billion in 2000 3 — or more than one-half of current spending totals. The National Council on Patient Information and Education was prescient when, in the 1980s, it characterized this then-nascent situation as “America’s Other Drug Problem.”

For nearly 30 years, NCPIE members have shared a belief that one of the best ways to achieve medicines’ full value — whether they cost pennies per day, or thousands of dollars per month — is to enhance communication between patients and health care professionals about their safe, appropriate use. In this same period, my own health policy career brought me inside national trade groups and professional societies of physicians and pharmacists; a multinational pharmaceuticals company; and, since 2004, with AARP — a founding NCPIE member. These groups represent some of the leading stakeholders dedicated to NCPIE’s mission, one that I championed directly for almost a decade while serving on NCPIE’s staff, as well.

Thus, as health care reform accelerates, I am fascinated by today’s patient-centered care chorus amidst a groundswell of “back-to-basics” mentality about the value of enhanced communication — the hallmark of NCPIE since its founding in 1982. Recent examples include:

“Science and technology have advanced enormously over the last decades but ultimately the best medical care requires deep knowledge of science as well as the skills to communicate effectively with patients.”4

“Effective communication with patients is important to improving the nation’s overall patient safety. “Many patients are called ‘noncompliant’ because they haven’t followed their doctor’s recommendations, but this may be because they don’t understand what is expected of them…. As physicians, we need to use less complex language with our patients when explaining their health conditions, surgeries, and taking medications. Asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend.”5

“Our relationship [with patients] must be built on trust, and that trust comes from communication and dialogue. It’s not important what we say, it’s what they hear.”6

Another NCPIE building block is recognition that a patient (and caregivers) must embrace his or her own role as an essential player on their medicine education team. Challenges presented by health literacy skills and cultural competency may tempt some clinicians to dispense with such an inclusive approach; and all patients may, at times, choose to play a lesser role. Recognizing that effective communication is a continual rebalancing process – especially where health outcomes are at stake with most people taking medicines at home, without hands-on supervision by a clinician — is what drives NCPIE’s momentum and messaging.

As NCPIE’s Chair, I look forward to championing this approach with you. Achieving full value from our medicines depends on it. Whether your organization is a veteran NCPIE champion, or is learning more about our coalition, feel free to communicate with me directly at: rucker@ncpie.info.

N. Lee Rucker, M.S.P.H.
AARP Public Policy Institute, Washington, DC
NCPIE Chair, Rockville, MD