Wednesday, December 14, 2011

Did I Take My Pills Today?

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill their prescriptions at all. According to the New England Healthcare Institute, (a health policy research organization focused on enabling innovation in health care.) medication non-adherence costs  the US health system an estimated $290 billion every year.

This non-compliance regarding medication is not a new story. In April 2007, I wrote a blog where I pointed out that not taking medication properly was the cause of more than 50% of medication- related hospital admissions. A study of 39,000 patients and 335 primary care doctors by the Consumer Reports National Research Center, published in the February 2007 in Consumer Reports, noted that doctors’ number one complaint about patients is their failure to follow advice and adhere to a treatment regimen, which results in the high numbers of people landing in the hospital or back at a doctor’s office with the same complaint that they brought to their physician days or weeks earlier.

A new study, which focuses on four chronic conditions, found that patients who regularly adhered to their prescription regimen significantly reduced their total health care spending and lowered the number of emergency room visits and the number of days spent in the hospital. Specifically, adherence reduced average annual health care spending by $7,823 for patients with congestive heart failure, $3,908 for hypertension, $3,756 for diabetes, and $1,258 in patients with high cholesterol according to the article.

There are three  reasons why people do not follow directions and take medication prescribed by their physicians:

1. Cost – many people, particularly those with chronic conditions who are on several medications come to a point where they have to make budget decisions and the pills are among the first things to go when money gets tight. The solution for these individuals lies not with changing their behavior but with the system. We have to find a way to bring down the cost of medications and co-payments to affordable levels so people can continue to take their medications . There have been several proposals that advocate paying people a financial incentive to comply with prescribed treatment such as lowering co-payments or creating incentives which reward people with cash if they comply.  To achieve a lasting solution, however, health insurers must begin to work with pharmaceutical companies and carve out plans for lowering the cost of some medications, as well as subsidizing \ individuals who cannot afford to pay.

A study funded by Aetna and the Commonwealth Fund, found that eliminating out-of-pocket costs for secondary prevention medications for patients after a myocardial infarction resulted in modest increases in adherence and improvements in some outcomes. This randomized trial showed adherence was roughly 4 to 6 percentage points higher among patients whose health insurers waived co-pays, than among those who continued to pay for prescriptions. Although these are not large percentages, it is good start toward making long term medication affordable to people with serious conditions.

2. Forgetfulness There are a large number of people who simply forget to take their medications either because they are too busy or they have memory lapses. The good news is that there are new systems with alarms available that remind patients when it’s time to take their pills - some even incorporate data collection to confirm that pills were taken on a regular basis. Devices like MedSignalsVitality Glo-Caps, and Dosecast, an app for the iPhone, IPad, iPod and iTouch that thelps you to remember when to take your medicines each day are examples.  Dosecast will even let you know if you have taken your last dose and if you are due for a prescription refill.
3. Education – patients frequently walk away from their visit with their doctor and have no understanding of why a prescribed medication is important and what will happen if they do not follow the treatment. Although there are isolated examples where physicians and pharmacists have worked together to develop effective programs to help people understand the purpose, potential side effects and why, using and completing a medication treatment is the only way the patient will recover, these coooperative programs are too few. As a result most patients are not given enough information and many opt not to refill their prescriptions. or they  self diagnose and determine that a drug is ineffective for them so they stop taking it. There are also the individuals who have difficulty swallowing their pills, or difficulty opening their containers, so they get frustrated and stop using their pills.

What can the patient do to take responsibility for medication adherence?

First and foremost, patients must speak up and question their providers about all of their medications and be sure that they completely understand why they are necessary, how to take them (in what dose and when), and the potential side effects. 

Patients who are still confused about a medications should talk with their pharmacist for further clarification.

Patients who have difficulty remembering to take their medications need to find one of the many medication reminders that are inexpensive  and available at the pharmacy,or free on many smartphones.

Patients who have difficulty opening the bottles should talk with their pharmacist who can supply bottles that are easy to open.
Patients who have difficulty swallowing should talk with their physicians who can prescribe substitute medications that may come in liquid form or who can suggest easier solutions for swallowing the medications.

Empowered patients do not leave these matters to chance or ignore the potential consequences.  They seek assistance and confirmation to make sure that they stay on track..

1 comment:

HealthMessaging said...

Great topic. There are several related issues regarding patient adherence worth noting.

Difference between intentional and non-intentional adherence. Forgetfulness would be an example of unintentional non-adherence. Intentional non-adherence includes issues like cost, which you mention, but also includes things like is the patient "willing" to take the medication prescribed by their physician.

Research shows that patients need to believe that the condition they are being treated for is serious enough to merit the medication and that there are no serious side effects to taking it. This requires the education piece you refer to. Unfortunately the average physician spends less than a minute teaching a patients how to take a new medication which simply isn't enough time.

Here's a post on the subject you might find helpful.

Steve Wilkins