The 'other' Drug Problem Poor Medication Adherence

We’re always looking for the next new “wonder drug,” the medication that will take us to new heights in keeping people healthy.  But what if the best drug for a medical condition is one we already have? In many cases, it is. But too many people are not taking their medications as directed.

According to one study, about 50 percent of people with heart disease or a major risk factor for it, such as high blood pressure or high cholesterol, have poor adherence to their medications. Nearly 25 percent of adults in the U.S. with Medicare Part D prescription drug coverage do not take their blood pressure medicine as directed–and it’s even higher in the District of Columbia at nearly 34 percent.

Medication adherence refers to taking medication:

• At the proper dosage
• At the correct time or times of day
• For the prescribed length of time

The consequences of not taking medication correctly can be severe. For example, not properly managing your blood pressure or cholesterol can lead to heart disease or stroke. Not taking a blood thinner after getting a stent to open clogged arteries increases the risk of a heart attack. One study showed that up to 69 percent of medication-related hospital admissions are related to poor medication adherence.

The simple idea makes perfect sense: Medication only works if you take it. The most important thing you can do is talk to your doctor if you’re struggling with a particular medication or your overall medication regimen.

In the meantime, let’s talk about some tips to better manage your medications and questions to ask when you’re prescribed a new drug.

Common reasons for not taking medication as directed

My patients have many reasons for not taking their medication as directed or at all. Some face multiple barriers managing their condition.

These can include:

• Forgetting: We’re human, and that means we sometimes forget things.
• Complexity of medical regimen: If you take multiple medications, or take different medications at different times of the day, it’s understandable that you may become confused at times.
• Cost: The cost of prescriptions is going up, which can prove a serious barrier for many people.
• Side effects: Some people fear potential side effects and won’t take a drug at all. Others may experience side effects that can range from annoying to life-threatening.
• Unable to see the benefits: We most often see this in patients with conditions that have no outward symptoms, such as high blood pressure or high cholesterol. It’s not like having a headache in which you take medication and the pain goes away. When someone with a chronic condition doesn’t take their medication, they may not see an immediate problem. In some cases, they may actually feel better when they don’t take the drug.

5 tips to improve medication management

Medication adherence can prevent future health complications, reduce the risk of hospitalization, improve your quality of life and even help you live longer. Here are five things you can do to help lower them or remove them entirely.

1. Be honest with your doctor

Openly share your success or problems taking your pills with your doctor–your health is at stake. Only through an honest conversation can we get to the heart of the issue and help solve a problem.   To effectively manage a health condition, it’s important to understand what’s working and what’s not. I can best tell how well a medication is working when you take it regularly. On the flip side, if I don’t know that you’re having trouble taking all your medication doses, that can complicate things further. For example, we might decide to increase your medication dosage or begin an additional medication, when the simplest solution would be to talk about ways to help you take your medication more effectively.  It’s possible that you may not need the drug at all, or you may need a different drug, but we can only know that for sure if you’re honest about your medication adherence.

2. Understand why you’re taking it

I’m always amazed when a patient admits that they don’t exactly know why they’re taking a drug: “Well, the doctor told me to.”   Doctors must do a better job educating our patients about why we’re prescribing a medication. Pharmacists play a role in this as well by reinforcing and reminding the patient about the importance and benefits of the drug.  If your doctor prescribes a drug and doesn’t adequately explain what it does and why you need it, ask questions until you understand. When you return for follow-up appointments, ask if it’s working and how they know. In some cases, you may be able to unofficially measure the results on your own. For example, if you take medication for high blood pressure, regularly monitoring your blood pressure at home may hint at if it’s working.

3. Get organized

Forgetfulness and confusion are the most common culprits I see when it comes to poor medication adherence. Often a few simple organizational tips and tricks can help sort this out.

• Think ahead. Prep your medications for the week or month.
• Use a daily, weekly or monthly pill pack.
• Set an alarm on your phone as a reminder to take your medication.
• Try a medication reminder app.

A 2006 study I co-authored showed just how effective a little organization can be. The trial followed 200 patients 65 and older who took multiple medications. Pharmacists bundled their medications in blister packs – a type of packaging in which you pop the medication out of a foil seal – with separate packs for morning, noon and night. After six months, medication adherence soared from 61 percent to an incredible 97 percent. Patients also experienced significantly lower blood pressure and cholesterol.

After six months, half the patients continued to receive personalized blister packs and the other half returned to usual care. The group who went back to what they had been doing dropped to 61 percent medication adherence, while the intervention group remained above 95 percent.

4. Inquire about a generic version

If you have limited, or even not-so-limited income, it can be almost impossible to sustain taking an expensive brand-name drug for an extended period of time. Many medications have a generic version, allowing you to save on out-of-pocket expenses. This can minimize the so-called “financial penalty” for being ill.

5. Ask if there is an alternative version

There are few classes of medication that don’t have an alternative option. You may want to inquire about a different version of your prescription if you:

• Take a drug multiple times a day: There may be an alternative form that can be taken once a day.
• Take multiple drugs: In some cases, we can prescribe a combination drug that includes two or more medications in one pill.
• Experience side effects: Not everyone can tolerate every medication, but an alternate version may produce fewer side effects.

Questions to ask your doctor or pharmacist about medications

There is much more that doctors, pharmacists, health plans and patients can do to improve medication adherence—including better educating patients, improving coordination and data-sharing between prescribing physicians and perhaps even incentivizing medication adherence.

But it all starts with ensuring the patient understands why a medication is being prescribed, what it will do for them and how they should take it.

If your doctor or pharmacist doesn’t explain it to you, speak up. Don’t leave their office until you have answers to these questions:

• What is it for and what are the benefits?
• How much does it cost?
• Is there a generic version?
• How do I correctly take it–how often, what time of day, with food, etc.?
• Are there alternatives, such as a combination pill?
• What are the side effects, and what is my chance of experiencing them?
• How long will I have to take it–for life or for a short time?
• Are there lifestyle changes I can make to help me get off this medication?

The next “wonder drug” is out there waiting to be discovered. But often the best solution is already in our hands; we just need to optimize its use.