Suspecting that the poorly controlled [insert name of chronic condition here] is the result of not taking the medication as prescribed, the doctor says: "Remember to take the [insert name of pharmaceutical here]!"After silently concluding that the benefit of the medicine is less than the cost, hassles, side effects and long-term risks, the patient thinks "Like hell!"
That scenario has probably been played out thousands of times today in clinics across the United States. According to Zachary Marcum and colleagues writing in the May 22 JAMA, that's costing $100 billion a year.
Doctors like the Disease Management Care Blog have responded to "medication nonadherence" with entreaties to take the pills as prescribed. When docs take the time to address the issue with patients, research shows it can make a positive difference.
Marcum et al believe physicians can do better if they understand the six types of behaviors that lead to medicines going unused:
1. Insufficient understanding of the link to health and well-being
2. A decision that the benefit is exceeded by the costs.
3. Complexity of the medication management overwhelms the patient
4. Inattention (or what the authors describe as low vigilance)
5. Irrational or conflicting beliefs about medicine
6. Perceived lack of efficacy
What does the population health management service provider community need to know about this?
1. There are a variety of screening surveys that can be used to identify each of the patterns above; unfortunately for DMCB readers, however, there is no single survey that can do it all.
2. There is also no single intervention that has been shown to consistently increase medication compliance. Instead, multiple concurrent supports are needed, including education and behavioral support. This paper by Ho et al echoes that assessment, pointing out that there is ample evidence that other valuable supports include reducing the number of pills, use of special containers, telemonitoring with interactive voice response, non-physician (nurse or pharmacist) one-on-one involvement and regular clinical follow-up with reminders. Last but not least this paper in the Annals points out that reducing out of pocket patient costs can also make a difference.
Image from Wikipedia
As an addiction doctor, and before that as a geriatric psychiatrist, I was always amazed at the enormous amount of medication patients would bring in when I'd ask them to bring all their meds to their first visit. Money was a fairly minor matter - most were covered by Medical Assistance - and almost always filled but rarely used their meds until time was spent explaining the med, its purpose and the benefits.
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