How to Adhere to Your Medication Schedule

Medicines don't do much good when they never leave the bottle. And yet the American Heart Association estimates that 12 percent of all Americans don't take their medications after getting a prescription. Another 12 percent don't fill their prescriptions in the first place. When patients do try to follow their doctor's instructions, they often miss a dose or take less than their doctors recommend.

The results can be disastrous. According to the AHA, 10 percent of all hospital admissions are a direct result of a patient's failure to take prescription medicines correctly.

Even health care professionals aren't always reliable when it comes to taking medicine. A study published in the Southern Medical Journal found that about 20 percent of doctors and nurses regularly missed doses. The most common excuse: They were just too busy or forgot to pop a pill.

Some types of medications are easier to neglect than others. People who have migraine attacks aren't likely to forget to take their painkillers. At the other end of the spectrum, drugs prescribed to treat "silent" conditions such as high blood pressure or high cholesterol are especially likely to collect dust in the medicine cabinet, says Nancy Houston Miller, RN, associate director of the Cardiac Rehabilitation Program at Stanford Medical Center. Over the years, she has seen countless patients who put their health at risk by not taking their medications. She also knows that most patients, with a little help and encouragement, can do what it takes to stay healthy.

Finding motivation

If your doctor has prescribed a drug that works without you noticing any changes, you may need extra motivation to take your pills. A little solid proof that the drug is actually working will go a long way. If you're taking medicine for hypertension, track your progress with a home blood pressure monitor. Likewise, you can buy a test kit to check your cholesterol levels. At a minimum, patients with high cholesterol should have their levels checked regularly, Houston Miller says.

Antibiotics pose a special problem. Most patients start to feel better long before they get to the last pill. It can be very tempting to "forget" to finish the bottle, especially if the drugs are causing side effects. But if you stop taking your antibiotics before the prescription runs out, you could be creating a "super bug" that's resistant to antibiotics. The first few pills will have killed the germs that are especially sensitive to antibiotics, leaving the tougher germs behind. If you don't finish off these stragglers, they could rally to form a new, tough-to-treat infection.

Juggling prescriptions

Staying motivated is only half of the battle. Even patients who intend to take their pills religiously can make mistakes, Houston Miller says. They can take the pills at the wrong time of day, they may take the wrong number of pills, or they may take their pills on an empty stomach instead of with a meal (or vice versa). Slip-ups are especially common when patients try to juggle several prescriptions at once. According to the American Heart Association, nearly 60 percent of patients taking five or more medications take them improperly.

If you're having trouble keeping track of your prescriptions, a little preparation goes a long way. The job starts in the doctor's office. Make sure your doctor clearly explains exactly how every drug should be taken. If communication isn't your doctor's strong point, ask questions until you're satisfied. If you're still having trouble communicating, consider looking for a new doctor. If your doctor isn't available, talk to your pharmacist when you pick up the prescription. A pharmacist is a goldmine of information about medications, and can tell you how often the drug should be taken, whether it can be taken with meals, and whether you can take it with other drugs.

Your doctor also has a lot to learn from you. Be sure to tell him or her about every medication you're taking, including over-the-counter drugs and herbal supplements. Many drugs can interact in harmful ways with other drugs.

Low-income people make tough choices

For seniors and low-income people, high medicine costs may interfere with taking your drugs as directed. Although seniors are the group most likely to need medications, they're also the least likely to have insurance that covers prescriptions, according to AARP (formerly the American Association of Retired Persons). More than one-third of Medicare recipients whose incomes are below $21,000 lack any prescription drug coverage, according to a study by the association.

If you lack insurance, you'll pay a significant amount of money more for your drugs as well. A 2003 survey of more than 500 pharmacies nationwide found that uninsured Americans pay 72 percent more for common prescription drugs -- drugs used mostly to treat chronic conditions.

A 2002 survey, conducted by the Kaiser Family Foundation, the Tufts New England Medical Center, and the Commonwealth Fund, found that due to drug costs, 22 percent of seniors in eight states skipped doses or failed to fill their prescriptions at some point during the year.

This survey echoes a smaller 1997 survey of 600 adults in eastern North Carolina. Forty-four percent of those using prescription drugs tried to make ends meet by asking for free samples, taking less than the amount prescribed, or not filling their prescriptions, or a combination of these strategies, according to the state Department of Health and Human Services' Division on Aging.

If the cost of medicine is keeping you from taking your pills, talk to your doctor about alternatives. You may be able to take a lower dose or a cheaper generic brand.

Keeping yourself on track

Here are some more tips to help you take your medicine properly:

  • Take the medicine at the same time every day. As a reminder, you can combine taking your pills with another daily routine such as eating lunch or brushing your teeth.
  • If your medication regimen is especially complicated, ask your doctor or pharmacist to help you simplify things. For instance, it may be possible to take one larger dose each day instead of two smaller doses.
  • Consider using a pill box with a compartment for every day of the week. Some boxes even have compartments for specific times of the day.
  • Keep a medicine calendar and note every time you take a medicine.
  • Consider asking your spouse or someone else to remind you to take your medicines.

With the right approach, you can make sure you get the most out of your medicines. Your medicines, in turn, will help you get the most out of life.

References

Interview with Nancy Houston Miller, R.N., associate director of the Cardiac Rehabilitation Program at Stanford Medical Center.

American Heart Association. Statistics you need to know. 2002.

American Heart Association. Quick Tips for Compiance. 2002.

Corda, RS, et al. Adherence to prescription medications among medical professionals. Southern Medical Journal. June 2000. 93(6): 585-589.

Davidson, MH. Strategies to improve adult treatment panel III guideline adherence and patient compliance. The American Journal of Cardiology. March 7, 2002. Vol 89(5a): 8c-22c.

Tough choices: High Medicine Costs Hit Elderly the Hardest. Congressional Record, April 11, 2000.

Seniors and Prescription Drugs: An 8-State Survey. Kaiser Family Foundation. 2002.

Harmuth, Susan. Making Prescription Drugs More Affordable for Older Adults. Executive Summary: North Carolina Department of Health and Human Services Division on Aging. September 1997.

Home Use Tests. Cholesterol. U.S. Food and Drug Administration.

Lewis, Ricki, Ph.D. The Rise of Antiobiotic-Resistant Infections. FDA Consumer, 1995.

Brangan, Normandy, and Gibson, Mary Jo. FYI: The Cost of Prescription Drugs: Who Needs Help? AARP Public Policy Institute. October 2000.

Talking With Your Doctor: A Guide for Older People. National Institutes of Health.

National Association of State Public Interest Research Groups. Paying the Price: A 19-State Survey of the High Cost of Prescription Drugs. July 2003.

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