“DRUGS DO NOT WORK IN PATIENTS WHO DO NOT TAKE THEM” (Former Surgeon General C. Everett Koop) –The Challenge of Non-Adherence.

The last DOCTOR post was about overmedication with prescription drugs and how to talk to your doctor about “DESCRIBING”. “Describing” is tapering off of drugs no longer needed. *

This post is about a related problem, the non-adherence to prescription drugs and the often severe and adverse consequences of non-compliance.

Non-Adherence refers to those who: Failed to fill or refill a prescription; Missed a dose; Took a lower or higher dose than prescribed; Stopped a prescription early; Took an old medication for a new problem without consulting a doctor; Took someone else’s medicine; or Forgot whether they’d taken a medication. (A)

Physicians should confirm that each patient:
– Understands their medications by reviewing: brand or generic name; function; how, when, and length of time the medication is taken; possible side effects; foods, liquids and activities to avoid while on the medication; refills (if necessary); and medication storage.
– Physicians can ask: “This medication will be an additional expense, how does it fit into your finances?”
– Have family members or caregivers be part of the team to help with administration and provide reminders
– And finish with: “I have given you a lot of information, let’s review your understanding of the prescription(s). (B)

Here are some details on the non-adherence epidemic.

The numbers are staggering. “Studies have consistently shown that 20 percent to 30 percent of medication prescriptions are never filled, and that approximately 50 percent of medications for chronic disease are not taken as prescribed,” ….“This lack of adherence….is estimated to cause approximately 125,000 deaths and at least 10 percent of hospitalizations, and to cost the American health care system between $100 billion and $289 billion a year.” (C)

“Within two years of having a heart attack, nearly 1 in 5 people stop taking lifesaving cholesterol-lowering drugs known as statins, according to a new study. And nearly 2 in 5 end up taking the drugs in lower doses or less often than they should…” (D)

“Medications are dispensed with the expectation that they will be taken exactly as prescribed. However, most patients do not follow their doctors’ orders. Excuses take many forms: “The medication was too expensive,” “If 1 pill is good, then 2 pills should be twice as good,” or “I didn’t understand the directions on the label.”” (E)

“… Patients may be no adherent during different stages of their treatment. They may decide not to fill their prescriptions in the pharmacy and not start their treatment at all. Patients may use more or less than the prescribed treatment or use their medication at the wrong time. They may also discontinue treatment prematurely.” (F)

* “DEPRESCRIBING” – Is there an epidemic of prescription medicine overtreatment? Start CHOOSING WISELY http://doctordidyouwashyourhands.com/2017/04/deprescribing-is-there-an-epidemic-of-prescription-medicine-overtreatment-start-choosing-wisely/

(A) Medication Adherence in America:2013, http://www.ncpa.co/adherence/AdherenceReportCard_Abridged.pdf
(B) Teaching Patients about their Medications: The Keys to Decreasing Non-Compliance, https://healthcarecommunication.wordpress.com/2009/02/06/teaching-patients-about-their-medications-the-keys-to-decreasing-non-compliance/
(C) The Cost of Not Taking Your Medicine, by Jane Brody, New York Times, https://www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(D) Many people stop taking life-saving drugs after heart attacks, by Andrew M. Seaman, Washington Post, https://www.washingtonpost.com/national/health-science/many-people-stop-taking-lifesaving-drugs-after-heart-attacks/2017/04/21/705a28e8-253e-11e7-a1b3-faff0034e2de_story.html?utm_term=.14225b93cfe6
(E) Medication Nonadherence: Finding Solutions to a Costly Medical Problem, by Harold Gottlieb, Medscape, http://www.medscape.com/viewarticle/409940
(F) Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions, by Jacqueline G Hugtenburg et al, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711878/


Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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