Every day, millions of people with chronic diseases miss their best chance to control their conditions and improve their health. They may see their doctor regularly, eat right, and exercise, but they skip one of the most important parts of their health plan: their medicine. Overall, 30 to 50 percent of all people with chronic diseases fail to take their medicines as prescribed -- and they can't all chalk it up to mere carelessness or forgetfulness.
When it's on purpose
A British study published in the journal Quality and Safety in Health Care highlighted a surprising and disturbing fact about this health crisis: Many people stop taking their medicine on purpose. Researchers surveyed 258 people who had just received a new prescription for a chronic disease. Within just 10 days, nearly one in three patients were already missing doses, and nearly one in 10 had stopped taking their medicine completely. (These figures didn't include the small number of patients who stopped taking medicine under advice from their doctors.) Among those patients who missed doses, 45 percent said they did so intentionally.
Patients had different reasons for purposely skipping their medicines. (Because the study was conducted in a country with universal health care, cost wasn't an issue.) Some were troubled by side effects, some had difficulty swallowing the pills, and some simply didn't believe that the medicines would help. Notably, more than half of all the patients in the study said they wished they had more information about their medicine. Of course, the best way to offset the information gap is for patients to make sure they ask their doctors what their medication is for, why they should take it, and for how long. Many people, however, don't ask, and they don't tell their doctors when they stop taking their medicine.
Other patients around the world have their own reasons for not taking their pills. Many patients stop taking medicines when they feel better, an understandable but dangerous decision. Conditions such as high cholesterol or high blood pressure can threaten health even when a person feels perfectly fine, and infections can gain strength when a person stops taking antibiotics too early (as well as contributing to the problem of antibiotic resistance). Other people stop taking medicines when they feel worse, perhaps because they blame the medicine or lose hope.
The decision to skip treatments isn't always made lightly. Many people can't afford prescription medicine. Others may have cultural or religious beliefs that make them reluctant to stick with a treatment. As reported in the Annals of Pharmacotherapy, Muslims and Seventh-day Adventists may stop taking pills containing gelatin that might be derived from pork or beef. And according to a report in Postgraduate Medicine, a distrust of medical doctors may keep some African Americans from following medical advice.
Staying informed, staying on track
Good information can be both an aid and a powerful motivator for patients who want to get the most out of their medications, says Brian Haynes, PhD, MD, a diabetes specialist in Hamilton, Ontario. Patients need to know the real benefits and risks of every medication, he says.
"If patients have any questions or doubts, they need to get those cleared up," Haynes says. "Hopefully they can talk with their practitioner, but there are lots of other sources of information." Pharmacists and reputable Internet sites can give patients the information they need to stick to their health plan, he notes.
In many cases, patients just need a little reassurance, Haynes says. They need to know that side effects can often be managed or prevented, or that their physicians can likely prescribe a different medication if they find the side effects intolerable. Doctors and pharmacists can remind patients that it's important to keep taking medications such as blood pressure medicine or the full course of antibiotics even if symptoms fade. A thorough discussion may even help avert problems caused by cultural or religious beliefs. If a doctor knows that a patient may throw away pills with gelatin, for example, a different prescription might help keep the patient on track.
A study published in the Journal of the American Medical Association found that a little information helped elderly patients with hypertension and high cholesterol take nearly every pill as prescribed. Like many older people, study participants had to take several different pills, often at different times. Doctors took extra time to explain the instructions for taking the drugs as well as the potential side effects and benefits. The patients also had follow-up visits with pharmacists, and they received their pills in special packaging. All of the pills that a patient was supposed to take at a given time, for example, were grouped together in individually labeled blister packs.
After six months, the new approach worked to near-perfection. Not only did patients take their pills on schedule, they also enjoyed reductions in blood pressure and LDL ("bad") cholesterol. But when treatment went back to normal, it only took a few months for patients to fall back to their former habits.
It's no wonder the National Council on Patient Information and Education calls missed doses "America's other drug problem." Like the original, this drug problem won't go away, but with close doctor-patient partnership, it can be relieved, patient by patient.
Interview with Brian Haynes, PhD, MD, a diabetes specialist in Hamilton, Ontario.
Barber, N. et al. Patients' problems with new medication for chronic conditions. Quality and Safety in Health Care. 2004. 13: 172-175.
Lee, J.K. et al. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol. Journal of the American Medical Association. December 6, 2006. 296(21): 2567-2571.
McDonald, H.P. et al. Interventions to enhance patient adherence to medication prescriptions. Journal of the American Medical Association. December 11, 2002. 288(22): 2868-2879.
Douglas, J.G. et al. Barriers to blood pressure control in African Americans. Postgraduate Medicine. October 2002. 112(4).
Sattar, S.P. et al. Inert medication ingredients causing nonadherence due to religious beliefs. 2004. 38(4): 621-624.
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