Are you taking your pills as prescribed? – Part iI
Noncompliance with prescribed medications and doctor’s orders has reached epidemic proportions. Up to 75 percent of Americans -- including those discharged from the hospital after a life-threatening illness -- acknowledge that they don't always take their pills as prescribed.
Such behavior creates a great burden on our health-care system. Let’s look at the main causes and at ways we can improve patients’ compliance with prescribed medications and instructions.
Inattention and inertia: These are two fundamental features of human behavior. Most of us have a short attention span, and people -- and patients -- like to listen to what is pleasing and do what is immediately pressing while neglecting or postponing unpleasant tasks.
That’s a major barrier to medication adherence, and physicians should engage patients in productive discussions about their illness. They should be constantly reminded to follow the correct regimen.
Lack of health literacy: Many patients don’t understand how or why they got sick, the nature of their illness, nor the proposed treatment regimen.
Often when I ask a new patient who has been treated by other physicians what they were told about their illness, the standard answers are “Oh, he didn’t explain it to me” or “I didn’t quite understand.”
Patients often are ashamed to ask questions for fear of sounding stupid. The only way to get over that is for the doctor to sit down and explain (using appropriate diagrams, models or other tools if needed) in simple terms the details of their disease and the proposed therapy.
And every patient should learn as much as possible about their illness and the drugs they are taking.
Language and cultural barriers: These play a major role in the cases of immigrant patients who may have poor grasp of English or when doctors don’t understand a patient’s local customs and expressions. For instance, one of my Spanish-speaking patients took the wrong dose of the drug I prescribed because he didn’t fully understand what I suggested.
Many don’t understand the time concept for dose regimens, so the doctor has to spell out what time of the day each dose should be taken.
Lack of financial resources: This is a major problem because some modern
medicines, especially cancer drugs, are quite costly and many patients, even those with insurance, can’t afford them. A lot of people have lost their jobs and put off purchase of medications, but they are reluctant to tell their doctors. So physicians must be aware and try to find the cheapest alternative when prescribing.
Barbara Sweinberg, director of our Crescent Community Clinic in Spring Hill, says,
“When patients at a free clinic are given prescriptions and they cannot afford to buy them, and if the pharmaceutical company has an assistance program, then they are enrolled in it and receive a year’s worth of medicines free. These patients mostly stay on their meds.
“However, those indigent and poor patients not enrolled in the program and do not have
transportation to get to the pharmacy often skip their meds.
“Physicians at free clinics try to prescribe the cheaper medicines that large pharmacies have at low cost or free. Insured elderly with or without drug plans and on fixed incomes often reach the ‘doughnut hole.’
“So when they are prescribed medicines that are not covered by the insurance plan or do not have enough money to pay copays go without meds or try to stretch out meds by taking every other day or cut the dose into half.”
Whenever possible I try to prescribe generic drugs that are effective and cheap. Thankfully Wal-Mart, Publix and other major pharmacies dispense several life-saving medicines at $4 for a month’s supply.
So patients, please check the catalogs of pharmacies first before you pay a higher price for any drug. Some such as Lisinopril (anti-hypertensive) and Metformin (for diabetes) are free from Publix.
My thoughts on this subject will conclude in the next issue of Khaas Baat.
