Taking Your Medicine

If you take any medication on a regular basis, chances are you’ve forgotten a few pills, or fudged the dosage amount. That’s no big deal, right? Wrong. Medication compliance is critical, and disregarding instructions for taking medicines can have serious or even deadly consequences.

Experts with the Methodist Health Care System define medication compliance as “the extent to which a person’s use of medications coincides with medical or health advice.” Noncompliance, on the other hand, is “a substantive deviation from the way in which the medication is prescribed,” says Dan Stryer, M.D., acting director of the Agency for Healthcare Research and Quality’s Center for Quality Improvement and Patient Safety. That definition applies to both prescription and over-the-counter medications, Dr. Stryer says. For example, while missing one dose out of 30 may not be described as a “substantive deviation,” missing five or 10 would be.

Problems associated with noncompliance

According to a 1998 report by the Council on Scientific Affairs of the American Medical Association (AMA), most studies have estimated noncompliance rates between 30 percent and 50 percent among patients. And those may be low estimates, Dr. Stryer notes. “I wouldn’t be surprised if it actually may be higher than that,” he says. “I imagine it’s probably closer to 75 percent.”

Medication noncompliance is a serious problem for a wide range of diseases, resulting in adverse health and economic outcomes, the AMA report states. It lists several disturbing consequences of noncompliance, including:

increased hospitalization, with estimates between 2.9 percent to 11.4 percent of admissions to hospitals resulting from failure to comply with prescribed drug therapy;
cases of patients with various diseases dying, failing to recover or having their conditions worsen; and
increased direct costs that range from the added expense of unused prescriptions to additional physician office visits to increased hospitalizations, and indirect costs from lost productivity, absenteeism and lost earnings.

In fact, an Ohio State University study found that noncompliance with prescription medications causes 125,000 deaths and costs an estimated $75.6 billion annually.

Noncompliance takes a toll both on an individual basis and on a societal level, Dr. Stryer points out. For example, noncompliance with antibiotics regimens can cause bacterial resistance to the medication, resulting in big problems for sick patients and the doctors trying to treat them, he says.

Causes of noncompliance

There are many reasons people don’t comply with medication instructions, and the problem affects all segments of the population—although elderly people may be at higher risk.

Issues influencing compliance include:

the “health literacy” of patients—the ability to read and understand medication instructions
psychological traits and behaviors
forgetfulness or dementia
cost considerations
lack of information or incomplete information about medicines from physicians

Even highly motivated people may have trouble following medication regimens, especially those with multiple prescriptions or complicated instructions. “It’s just hard to follow a regular course of medication if it’s more than once a day,” Dr. Stryer says.

Help with compliance

Experts offer a wide range of suggestions for helping with medication compliance—although the best compliance aids vary depending on the person.

Before starting a new prescription, ask your doctor about the name of the medication, any potential side effects, the condition it will treat, how it works, when and how you should take it, how long the regimen will last, if it will interact with other medications or foods, what to do if you forget a dose and if you can take home printed information about the medicine.
Tell your doctor if you are or might become pregnant, and if you have any medicine allergies.
Work with your doctor while you’re taking medications. Ask about results of tests that show how the medications are working for you, and be sure to bring up any problems you have with them. Discuss how you have felt since you started taking the medication.
Keep a detailed record of all medications (including over-the-counter and herbal) you take and discuss them frequently with your doctor and pharmacists. Drug interactions can be fatal.
Read all dosage instructions—whether the medication is a prescription or over-the-counter—and follow them exactly, including using precise measurements. Heed warning labels. Make sure you understand the directions, and ask your doctor or pharmacist if you have any questions. Post any printed instructions in an obvious place.
Don’t use medications after the expiration date. Throw out old medicines in a place where children or pets can’t find them.
If cost is a concern, ask about a generic version or other lower-cost options.
If necessary, use special devices to help you remember your medication regimens, such as pillboxes, beepers, alarms or timers.

Dr. Stryer emphasizes honesty and communication as the two most important factors in medication compliance. “People have to be honest with themselves and question whether the real problem they’re being noncompliant is that they just don’t remember, or because of some other reason,” he says. “The important thing is that patients talk to their providers and pharmacists about these issues. We should be able to figure out ways to make medication fit with their lifestyle and priorities. They shouldn’t assume they have no choices.”

by Kristin Knight
©2003-2009 Achieve Solutions®

Resources

National Council on Patient Information and Education
www.bemedwise.org

National Institute on Aging: www.nia.nih.gov/health/agepages/medicine.htm

The Agency for Healthcare Research and Quality: www.ahcpr.gov/consumer/ncpiebro.htm

U.S. Food and Drug Administration: www.fda.gov/fdac/features/196_kid.html

Sources: Dan Stryer, MD; The Agency for Healthcare Research and Quality; American Medical Association; Behavioral Associates; Methodist Health Care System; National Council on Patient Information and Education; National Institute on Aging; Ohio State University Research News; The Risk Management Foundation of the Harvard Medical Institutions; U.S. Food and Drug Administration; Drug Interactions: Protecting Yourself From Dangerous Drug, Medication, and Food Combinations by Melanie Apel Gordon. The Rosen Publishing Group, 1999.