WASHINGTON, D.C. (AP) – Consider it the other drug problem: Millions of people don’t take their medicine correctly – or quit taking it altogether – and the consequences can be deadly. On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week. It calls the problem a national crisis costing billions of dollars.
Some tips to help patients take their medicines correctly, from the not-for-profit National Council on Patient Information and Education:
- Before leaving the doctor’s office with a new prescription, ask detailed questions including: How and when do I take this? When do I quit? What food, drink, other medicines or activities should I avoid while using this medicine? What is it supposed to do? How do I know if it’s working? What are its possible side effects? What do I do if have those?
- Bring to each doctor’s appointment a complete list of all prescription and nonprescription medicines you take, so the doctor can check if a planned new drug will interact badly with an existing one. If you use one pharmacy exclusively, the pharmacist can print out a prescription list for you.
- If you have problems understanding the instructions that come with the medicine, ask the pharmacist for help. There may be a simpler brochure, large-print instructions or translations into languages than English.
- Patients who forget doses could try setting up pill boxes at the beginning of each week with morning, noon and night doses in separate compartments. Technology including “talking” pill boxes that sound an alarm when doses are missed also are under development.
- Ask about medication adherence at every visit and check for evidence, such as symptoms not improving or missed refills.
- Consider easiest-to-take regimens first, including once-daily doses and combination products for people who need multiple drugs.
- Be willing to consider other treatments if patients’ fears about side effects or other issues suggest they won’t comply.
The government is preparing new steps to try to persuade patients and their doctors to do better.
But with contributors that range from too-hurried doctor visits to confusing pill bottles, there’s no easy solution.
“We go into this with some humility,” says Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an “in your face” campaign to improve medication adherence. “It’s really pretty appalling how badly we do.”
It’s not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is President Bill Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery to avoid a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.
For most diseases, however, patients must choose to take their medicines. The new report combs a decade of research to conclude people generally do a lousy job. Among findings from the not-for-profit National Council on Patient Information and Education:
- Particularly at risk are people whose diseases are initially symptom-free. Although high blood pressure more than triples the risk of heart disease, for example, just 51 percent of patients stick with their prescribed antidote.
- Also at high risk are the elderly, but adherence is a problem for all ages. As few as 30 percent of teenagers correctly take drugs to prevent asthma attacks, for example.
- Dire consequences aren’t always a deterrent. Among patients already blind in one eye from glaucoma, only 58 percent were protecting the other eye. Another study found 18 percent of kidney transplant recipients weren’t following instructions to prevent organ rejection.
- Even doctors mess up, acknowledging in one study adhering to their own prescriptions just 79 percent of the time.
- Poor medication adherence can cost an extra $2,000 a year for each patient in extra doctor visits alone, and it’s associated with as many as 40 percent of nursing home admissions, even more costly.
- Add preventable hospitalizations and premature death, and the report estimates that poor medication adherence could be costing the country $177 billion in medical bills and lost productivity.