Addressing Loneliness as the Key to Improving Medication Adherence

It’s common knowledge: medication adherence improves health outcomes, and can have outsized impact for patients and health plans alike. Poor medication adherence costs our systems billions of dollars a year. Yet, less than 50 percent of patients with chronic conditions take their medicine regularly. Non-adherence is estimated to account for up to 50 percent of treatment failures, around 125,000 deaths, and up to 25 percent of hospitalizations each year in the U.S.

Poor med adherence is rampant among those in low socio-economic groups, which also demonstrate high rates of loneliness and associated heightened levels of stress and feelings of vulnerability. It is well known that those of low socio-economic status have high social determinants of health (SDOH) needs that when left unresolved create these stressors, vulnerabilities, and poor health outcomes. SDOH is defined as the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. In fact, these determinants have been shown to have a greater influence on health than either genetic factors or access to healthcare.

Health literacy is well known to contribute to poor medication adherence, as are other SDOH factors including transportation needs, economic instability, housing needs, or employment struggles. Layer in the challenge of identifying and mitigating SDOH needs, and the health system may find itself struggling to uncover root causes of why patient health may not be improving despite proper treatment plans.

For example, basic health literacy — or the ability to obtain, read and understand healthcare information in order to follow instructions for treatment — is one SDOH that’s strongly associated with low medication adherence. But there are many other SDOH factors to consider, including economic instability (which forces difficult decisions, like skipping medication doses in order to extend a script’s duration); housing insecurity (many consider having a roof over their heads their top priority, higher than refilling a medication); job insecurity and lack of transportation (according to one study, 65 percent of patients said transportation assistance would improve their medication use after discharge).

Faced with combatting lower care quality and increased acute care utilization due to lack of med adherence, where should the healthcare system start? Perhaps a rather unlikely place: by addressing loneliness. Here’s what we know about loneliness:

1. Loneliness is much more prevalent in groups with lower socioeconomic status, and this prevalence increases with age.
2. Loneliness is strongly correlated with some of the most impactful SDOH factors affecting med adherence.
3. Reducing loneliness not only improves social health, but mental and physical health—particularly for those with chronic conditions.

Could it be, then, that addressing loneliness is the most underrated, yet productive way to target all SDOHs, and consequently, improve med adherence? We believe the answer is yes. But there are challenges. 

On the patient level, chronic loneliness leads people to avoid social connection. People experiencing loneliness have trouble breaking unhealthy cycles of reclusion; and may develop a distorted reality about the world around them, misreading facial cues and seeing rejection when others would not. This makes it difficult for an individual to get the social supports they need to overcome SDOH factors on their own. 

Systemically, loneliness is not readily identified through consistent screenings in our current healthcare system; nor do many health plans or providers have the tools needed to address it properly.

The health care system needs to focus on proactively improving med adherence in the following ways: 

• Screen for loneliness: As part of an SDOH strategy, consistently screen for loneliness to identify those patients who are at highest risk for factors contributing to poor med adherence. Then, once identified, implement strategies that focus on and engage these patients in their social and physical health. Tools such as health and patient engagement apps, health portals and care management staff can be useful to keep in touch with them to make sure they are taking their medications as prescribed. Pay particularly close attention to those patients who may have been prescribed medications upon a hospital discharge, as studies have shown this is a particularly vulnerable period of time for those already prone to non-adherence, often leading to adverse events.  
• Address loneliness at scale: It may be virtually impossible to keep close tabs on so many patients at risk for loneliness. Often, the most efficient and effective way to address the magnitude of the loneliness epidemic is to combine technology and human supports. In other words, engaging technology can be used to screen for loneliness, and those individuals screening as lonely can be selectively targeted for ongoing, human follow-up from supportive, compassionate individuals.  
• Leverage loneliness data to connect people with appropriate services in their area: As you gather data on lonely patients, prioritize those patients to identify and solve SDOH needs, actively assist to connect them to resources – for example, transportation or delivery services; grants for transportation programs; food banks where they can access healthy food (food insecurity is known to instigate a downward spiral for medication adherence). The result of such connections is improved self-efficacy and empowerment to take advantage of available resources. Ultimately this helps improve SDOH and medication adherence and allows for the physical and emotional support they need to engage in their health.

Ensuring proper medication adherence is a core component of high-quality care. It helps dramatically improve overall population health and reduce avoidable expenditures, including inpatient and emergency room costs. This is why it’s vital to make sure patients take their medications as prescribed – and addressing loneliness at scale offers an ideal conduit for doing this.