Prescriptions won’t work unless you follow instructions
By RITA RUBIN
USA TODAY
Former U.S. surgeon general C. Everett Koop often is quoted as saying, “Drugs don’t work in patients who don’t take them.”
Yet, study after study shows that in the United States and other developed countries, only about half of people with chronic health conditions continue to take medication as directed. Doctors say the problem cuts across all socioeconomic groups, and the problem often goes unrecognized.
“You only get 20 to 30 minutes per patient visit,” says P. Michael Ho, a cardiologist at the Denver VA Medical Center and the University of Colorado Health Sciences Center. “After you’re done dealing with the five or six medical problems, you really don’t have time to address whether the patients are actually taking the medications they’re supposed to.”
Heart attack survivors don’t take their medicine for high cholesterol or high blood pressure. Epilepsy patients skip their anti-seizure drugs. Breast cancer patients stop taking pills that reduce their risk of a recurrence. Osteoporosis patients forgo medication that will be able to reduce their risk of a fracture.
Costly neglect
Reasons for this lack of adherence - the term doctors use - are complex, and quick fixes are few. Not surprisingly, patients with chronic conditions who quit taking their medicine don’t fare as well as patients who take their pills religiously.
“Adherence is a huge problem, costing billions of dollars,” says Alexandra Papaioannou, a geriatrician at McMaster University in Hamilton, Ontario. “Obviously, if you don’t take the drug, you won’t have the full benefit.”
About 20 percent to 30 percent of patients taking daily or weekly osteoporosis treatments quit six to 12 months after they begin, Papaioannou writes in the January issue of Drugs & Aging. The main reason is either side effects or fear of them, she and her co-authors write. Memory problems, depression and a daily regimen of many pills for other conditions also contributed to patients’ lack of adherence.
It helps to provide patients with written as well as oral instructions and to make sure they or family members review the instructions, Papaioannou says.
Irish researchers reported in January that 22 percent of the breast cancer patients they had studied stopped taking tamoxifen by the end of a year, even though they had been told to take the drug for five years. By the end of three and one-half years, more than a third of the women had stopped taking their tamoxifen.
No age difference
The oldest and the youngest were the ones most likely to quit taking tamoxifen, the authors wrote.
Decreased social support, such as fewer relatives to remind them, and a failing memory might help explain why the oldest patients stopped their tamoxifen.
The reasons younger women didn’t take their drugs are less clear, the researchers said. They speculated that the women might not adjust to their diagnosis as well as older women did.
Previous studies linked early discontinuation of tamoxifen to depression and to the drug’s side effects, such as hot flashes.
But part of the problem is misconceptions about medications, says Gbenga Ogedegbe, an internist at Columbia University. “Patients have all kinds of crazy beliefs about how medications can be poisonous.” Instead of a prescription drug, he says, they’d rather take a “natural” therapy, even though such products may never have been tested.
Prices don’t matter
Drug costs sometimes can be a problem, but even at Kaiser Permanente and Veterans Affairs medical centers, where co-pays are minimal, “there’s still a high percentage who don’t routinely fill their medications,” Ho says.
At least it’s easier to catch those unfilled prescriptions in a health system such as Kaiser and the VA, Ho says. “In the outside world, it’s much harder, because patients go to different pharmacies, different insurance plans, different doctors.”
Intuitively, education and income would seem to be a factor, but no well-designed study has ever found that to be the case, Ogedegbe says. The higher-income, better-educated patients he sees at Columbia are “very resistant to taking medicine.”
They tell him they hate the way diuretics, the “water pills” prescribed for high blood pressure, keep them running to the bathroom. “But they show up in your practice, which means they know they should be getting medicine.”
Examples of commonly used medical abbreviations
Here are common doctors’ shorthand direction and their meanings when used on prescription drugs:
ac: Before meals
pc: After meals
po: By mouth.
bd: Twice a day.
tds or tid: Three times a day.
qds or qid: Four times a day.
mdu: As needed.
prn: As necessary or when required
od: Once daily.
qd: Every day.
qqh: Every four hours.
Mane: In the morning.
Nnct: At night.
Source: Patient Health International, www.patienthealthinternational.com
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