The ongoing battle between patients and medication compliance
by Tim Robertson
“Drugs don’t work in patients who don’t take them.” — Dr. C. Everett Koop
I have seen this quote from the former U.S. Surgeon General used time and time again to highlight the opportunity of medication compliance in our health-care system. While this statement seems blatantly obvious, we often fail to communicate this very important topic. The health-care team (including the patient) has a huge barrier to overcome. How do we maximize the benefit of the life-saving medications that are available to treat chronic disease?
The Pink Stuff
Five-year-old Abigail goes to the doctor for a sore throat and comes out with a prescription for antibiotics. Even though it tastes pretty nasty, Mom pleads with her to take the commonly known “pink stuff ” three times per day for the full 10 days. Seems simple, but if you are a parent, you know how difficult this is to actually accomplish in the midst of school, work, nap time, changing little brother’s diapers and keeping the house clean for dinner guests. How many times have you been told to “take until it’s gone” or “finish all” but have been unable to?
I think we all know that antibiotics work best if taken for the full duration of therapy and yet most of us can admit to not following doctor’s orders at least once in our lifetime. Yes, the stakes are small here; maybe enduring a sinus infection for another couple weeks or even a perforated eardrum here or there, but what about chronic conditions? What are the stakes when we are talking about diabetes, depression, Pulmonary Hypertension or Huntington’s disease?
An injection? No way!
An accomplished teacher all her life, Barbara visits her primary care physician after experiencing several weeks of frequent urination and unexplained weight loss. She has had diabetes for years and takes her medication but she knows full well that something is wrong. She is shocked to learn that her diabetes has worsened and is being asked to take insulin via injection under the skin. Even though her doctor informed her that many people take insulin injections daily and that it really does not cause much pain, Barbara struggles to meet the goal of two daily injections, and often misses her evening dose. Does she not understand the devastating consequences of uncontrolled diabetes? Does she not trust the recommendation of her doctor? What is standing in the way of fully complying with the prescription that her doctor has given her?
Barbara has a life-threatening chronic condition, not unlike nearly half of all adults in the United States, according to the Centers for Disease Control (CDC). You would think that Barbara and her doctor would be doing everything possible to make the best use of the life-saving medication that was prescribed. But there is something else going on here. Barbara and her doctor are contributing to a compliance problem that is costing us $290 billion dollars annually. When medications are not taken as prescribed, we are not getting their full benefit and therefore, we are wasting money. She is also setting herself up to be one of the 125,000 Americans that die every year due to poor medication compliance. The numbers tell us we as a society have a problem, but do we really believe it?
The Five-minute Consult
The reality of today’s health care system is that we are busy and our physicians are equally busy. Barbara sees her physician every six months as he requests and gets about five minutes of quality time to discuss her health care. Do they ever get to talk about how often she forgets to take her insulin? How often does Barbara contemplate her compliance with her medications and what effect that may be having on her life expectancy?
In her job as a teacher, Barbara sends numerous e-mails to clients and co-workers, logs on to LinkedIn to keep in touch with colleagues in her field and related businesses, and keeps track of her finances online from her mobile device. She is not unlike most Americans in any given socio- economic status. Almost all of us participate very frequently in social media and other electronic means of communication when it comes to everything EXCEPT our health. For many reasons, we are hesitant to keep our medical information online and our physicians are hesitant to communicate with us outside of the office visit, but at what price? What is it going to take for us to start communicating as a health care team?
Full court press or one-on-one?
According to the National Council on Patient Information and Education, medication compliance is America’s “other drug problem,” and it is going to take efforts at every level to realize lasting improvements. Every member of the health care team has a stake in this game and everyone is at least talking about it. The American Medical Association (AMA) has position papers, CDC offers numerous articles and recommendations, almost every patient and provider organization references the problem and even Wikipedia has a nice online synopsis of medication compliance. There is no doubt that it will take a change in the way our health care system operates to make significant progress in the way patients take their medications, but the first step in this crucial battle is patient-physician communication. Both parties taking the time to agree on informed and realistic expectations will be time very well spent. Physicians giving their patients real and concrete explanations of the prescribed medication so that there are values associated with compliance is critical. Patients engaging in an honest relationship with their physician, listening to advice and demanding more when appropriate is absolutely necessary. We are wasting precious health care dollars here and it threatens our lives! So, take a look at how you are treating yourself and next time you are at your physician’s office, ask this question: “Are we doing everything we can do to maximize the benefits of the medications that have been prescribed?”
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