Monthly Archives: April 2017

Medication Adherence Is No Trivial Matter

By Hui Xie-Zukauskas

Med.Adherence n ProvidersPayers_CPDn2otherImagine you want that magic pill to lose weight or you just got the right drugs to effectively cure your illness, but in either case, you let the pills sit somewhere around your house… How would it help you?

Sadly, failure to take prescribed medications causes about 125,000 deaths annually, according to the CDC.

That’s why I talk about medication adherence and the consequences of non-adherence. Medication adherence implies that a patient takes the medication(s) prescribed by his/her doctor, following the dosage, time or frequency, duration and direction.

Issues on taking medications have been an age-old yet multifaceted challenge, which has some across-the-board consequences. Adherence is especially low among patients with chronic illnesses. And it often happens among elderly people too.

It may surprise you how significant this matter is. Let’s start with reasons for adherence.

Why should a patient take medications faithfully and rigorously?

Medication adherence and therapeutic satisfaction are profoundly tied together.

  1. Your adherence to correctly prescribed medication is essential to clinical-efficiency, cost-effectiveness and positive outcomes.
  2. Adherence to the right regime or course of therapy prevents the development of adverse drug events (ADEs) or adverse drug reactions (ADRs) in many ways.
  3. In the sphere of “cost”, if you try to reduce medication cost by taking it irregularly or delaying the refills, the full therapeutic pay off will not be achieved, and worst, a risk of declining health and increasing cost will transpire.
  4. Non-adherence can lead to hospital readmission, esp. in cases of critical health problems, and potentially affecting clinical quality improvement.
  5. Non-adherence is a $ Multi-Billion problem. “Between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the US annually.” (Iuga & McGuire. Risk Manag Healthc Policy. 2014; 7:35-44)

It’s worthy to emphasize that many biological events in the body take place between drug dose and its response, including the release of the drug, absorption, distribution, metabolism, secretion and clearance. Plus, drug interactions with coexisting substances or factors could be severe or subtle. So, non-adherence to medication could result in some unanticipated incidents.

So, what are likely roots of non-adherence?

They can be divided into TWO categories: System (external) and Patients (internal)

Systems / External to Patients – just name a few

  • Discontinuity of care – esp. from hospitalization to subsequent discharge home when lacking a proper direction
  • Multiple changes in medication regimens
  • Inadequate education or instruction of drug use to patients
  • Lack of information on side effects of drugs and preventative measures
  • Drug design itself: e.g. formulation, packaging, inconvenience or high cost, etc.

Patients / Internal Causes

  • Failure to fill the prescription at the start
  • Failure to refill the medications consistently
  • Forgetfulness – esp. in older people
  • Exhaustion of multiple medications
  • Discontinuity due to a side effect, fear of side effects, finance or misled information
  • Inappropriate use of medication
  • Intentional decision to not take the medication
  • Lack of understanding diseases or poor health literacy
  • Physical difficulties, esp. with swallowing big tablets or capsules, opening bottles or containers, or obtaining prescriptions.

Understandably, non-adherence may occur above all when a patient’s expectation for therapeutic benefits goes beyond the actual benefits, or when medication cost is greater than a patient anticipated.

If non-adherence is an issue for you, it’s time to reflect and deal with the root problem following the explorative list above. Surely it could be something outside it.

Finally – How can you stick to your medications?

Medical adherence is one of keys to better health care. Interventions to reinforce adherence from clinicians and allied health professionals need to be improved. On the other hand, I’d like to highlight what you can do to stay on your medication regimen and optimize your health.

10 Strategies & Tips for Medication Adherence

  1. Take a driver’s seat for your care. Before a drug prescription, talk with your physician to understand why the medication is needed and what benefits it produces. By making a mutual agreement or decision, it will enhance your adherence in the beginning.
  2. Counsel with a pharmacist at your local pharmacy if you have any concern or trouble with your drugs, and they are happy to help with adequate knowledge and advice. Bonus – it’s free of charge.
  3. Comply with the instruction. This is very important as mentioned earlier that drug dosing can impact your body in various ways. For example, some drugs need to be taken in the morning and others in the evening; some once a day, others four times a day; some with a full stomach, others with an empty one…
  4. Have a self-management system – i.e. use a pillbox, take the medication at the same time each day and ideally couple it with a specific daily task or routine, color-code different time points, refill the medications at the same time each week, and order your medications 7-10 days ahead… you got the idea. It’s practical and effective, esp. for older people who use multiple drugs or drugs that must be taken several times a day.
  5. Find a creative way to remind yourself. It could be a sign, a framed memo or a decorated item/box, or an alarm. And make sure it’s absolutely visible.
  6. Take advantage of technology. It could be a medication reminder app or a dedicated digital calendar. Most helpful, set the alarms, esp. smartphone reminders or some cell phones allow you to set multiple alarms a day.
  7. Reduce financial stress by trimming costs down. If your meds cost too much, consult with your pharmacist for a generic brand or current regimen adjustment. In addition, you can switch to a mail-order pharmacy, which certainly offers more savings.
  8. Get help and support from family members, care givers or doctors whenever necessary, e.g. reminder, refilling, or ideas.
  9. Change attitude and take control of your health. Concerns, denials or doubts are real, but none of them is the right solution to your illness. Find a motivation to take that pill, and it should be bigger than you.
  10. When you travel, make sure to take an extra 1-2 days of medications in case of a delayed schedule. Always keep your meds in your carry-on bag. On a similar note, if you’re dining out, take the required meds with you.

The Take-Home-Message:

#1  “Drugs don’t work in patients who don’t take them”. 

#2  Drugs don’t perform well in patients who don’t take them with a right dose, at a right time and in a right way.

#3  Medication adherence can maximize therapeutic benefits. Failure to do so causes considerable health, clinical and economic consequences.

 

Image Credits: Pharmaceuticalonline.com; Lifescript.com