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Medication Compliance

This article first appeared in the Mar/Apr 2010 print issue of PA TIMES.

Traci Foster, David Milen

Patient compliance of medications is a growing concern within the health care industry and considered a highly sensitive issue. It has been noted that approximately a quarter of patients do not take their medications as prescribed. Approximately 125,000 deaths are due to improperly taken medications. Furthermore, patients will incur increased doctor’s office and hospital visits due to improperly following pharmaceutical orders, or not taking medications at all due to possible resistance.

Noncompliance further leads to a deterioration of the patient’s health which can ultimately lead to a lower quality of life or even possibly death. When patients are not taking their medications, the likelihood of physician office visits or hospitalizations are increased. Some of the consequences of noncompliance also include a missed health benefit as well as productivity issues in regard to lost work time and wages.

Patients’ Perspectives

Factors that influence the patient’s compliance with medications include the following: age, memory problems and dose related problems or medication information errors. Another possible cause includes the variety of pills that the individual is already taking on an everyday basis for more than one medical condition.

Patients may forget they have taken their medications and have an increased likelihood of taking them again. Some patients, due to their age, forget to take medications altogether. While forgetfulness on part of the patient is also factor it is seen as an unintentional non compliance. Regardless of memory loss or forgetfulness, the fact remains that if the patient does not take his/her medication then it is not beneficial to the patient.

Some individuals do not take their medications in order to ration their supply. This is generally due to cost issues. Furthermore, cost is usually the deciding factor in the patient decision not to get them refilled. In addition, some patients do not fill the initial prescription due to cost issues. Medication management for more than one chronic
condition can be a great challenge to the elderly individual.

Examples of these include congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes to name a few. In fact, noncompliance with medication is a well-known problem in patients with CHF, economic costs of noncompliance are assumed to be high in CHF, and interventions are frequently ineffective or not well accepted by patients.

Medication Compliance

Medication compliance by the patient is very important. Taking medications as prescribed and continuing therapy for the duration is most vital. However, patients do not take their medications as prescribed, this includes completing the regimen. Some patients feel that they are not that sick or are no longer sick, and stop their regimen prior to finishing the prescription.

Also, some patients see that their symptoms are improving from the medication being taken and do not complete the regimen, but save medications for a possible future occurrence. An example of this is generally seen with antibiotic therapy. Patients are instructed to take their regimen for a period of 14 days. What happens quite frequently is that the patient begins to feel better after a few days therapy. The patient then decides that he/she will save the remaining pills for a “future” illness, thereby avoiding an unnecessary trip to the doctor.
What factors need to be addressed in helping compliance? In this particular case, education is most important. Education showing the patient the benefits of completing the whole antibiotic regimen is central. Most importantly, the most important interventions are those that will promote a behavior change that is for the long term.

Interventions

There are several interventions that can be addressed in order to help a patient be compliant with their medication regimen. First, and most importantly, is the relationship between the patient and the provider. A central point to the successful delivery of primary health care is the relationships established between physicians and patients. The patient must trust the physician or nurse practitioner, and communication and trust between the patient and the health care provider is significant. The provider needs to ensure the patient understands the reasons behind taking the medication as well as what the dosing regimen will be. The patient also needs to understand the risks involved if altering the dosing regimen or stopping it altogether.

Today, cost is a factor that drives patient compliance of medications. Patients do not have the benefits of health insurance and have to pay the full cost of medications. A cost saving alternative is using a generic brand of the medication; however, that is not available with every medication. There are hundreds of prescription medications that are available or at a reduced cost; however, not all drugs are available.

Some patients also live on a fixed income and the price of medication may not be obtainable. Therefore, the provider can offer free samples of the medication or write for the generic equivalent if available. There are also prescription assistance programs that are available that may help the consumer. Approximately $4 billion annually in patient costs and 22 million prescriptions were provided free or at a greatly reduced rate.

With reduced medication costs or patient prescription assistance programs medication compliance increases. On the other hand, studies also show that medication compliance increases with higher incomes. In comparison, compliance also increases with reduced medication costs. This further demonstrates the need for providers to take this into consideration when writing the prescriptions for the patient.

In the United Kingdom (UK) prescription medications are free to 85 percent of the population,, but despite having this benefit compliance is no higher in this country versus a country with no access to free medications. Other interventions include medication monitoring devices. There are many types of monitoring devices. This may include pill boxes, timers or even watches that beep to remind a patient to take their medication.

Lastly, offering value-based insurance design (VBID) suggests an improvement in medication compliance. VBID’s are also called evidence-based benefits and value-based design. VBID’s reduce co pay costs for medications that are most important while increasing the co pays for drugs and tests that do not seem worthwhile.

Medication compliance is an important issue for the health care industry and the patient. Taking medications as prescribed generally grants the patient an improved health status. The key is to make sure that the patient understands the benefit that he/she should see when taking the prescription as indicated.

Physicians or the nurse practitioner should discuss a timing regimen that is suitable for the patients and take the time to educate the patient on side effects. Furthermore, they should indicate when a patient should follow up, either for an adverse affect of the medication or a general follow up visit to ensure that the patient doesn’t require a longer medication regimen.
Since costs are a factor in filling the initial scripts as well as refills, the provider should be aware of the patient’s financial and insurance availability to best prescribe medications that might have a generic form. They can also instruct the patient on what other programs may be available to offer free or reduced cost medications. The goal is to ensure medication compliance for the patient and the health care provider needs to be creative in his/her interventions to help the patient succeed in receiving an improved health benefit by taking his/her medications.

Traci Foster is nursing manager at St. Margaret Mercy Hospital. Email: traci.foster@ssfhs.org

ASPA member David Milen is bioterrorism/disaster preparedness coordinator at St. Margaret Mercy Hospital. Email: david.milen@ssfhs.org

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