Patients Too Often Fail to Follow Drug Regimen by Dr. David Lipschitz on Creators.com

Recently

High Blood Pressure Kills Silently, Worsens With Age High blood pressure is a major risk factor for heart disease, stroke, and peripheral vascular and kidney disease. In the United States, 30 percent of the entire population over the age of 18 has hypertension as defined by a top or systolic pressure …Read more. Research Grants Kindle Medical Breakthroughs America has long been a world leader in pioneering medical research discoveries. The scientific breakthroughs in the last century were breathtaking, and now the future looks even brighter. Two cornerstones of our nation's research accomplishments …Read more. Aspirin Health Benefits a Matter of Risk Vs. Risk Aspirin, first developed as a painkiller almost a century ago, is still viewed by many as a miracle drug. While rarely prescribed for pain, aspirin's major use is its effect on platelets. Aspirin prevents the formation in platelets of a molecule …Read more. Alternative Therapies Can Help but Also Harm In every aspect of our lives, natural is touted as being better, and health care alternative therapies are all the rage. A recent report published in the Journal of the American Geriatric Society stated that 80 percent of people over the age of 65 …Read more.

Patients Too Often Fail to Follow Drug Regimen

Are you taking more than three prescription medications daily? If so, there is a 70 percent chance that you're taking them incorrectly or not taking them at all.

Not surprisingly, noncompliance is one of the major reasons why treatments fail. A recent article published in the New England Journal of Medicine describes a study that monitored medication use electronically. It found that most noncompliant patients would omit taking a medication altogether rather than taking the drug at the wrong time or taking the wrong amount.

Noncompliance is much more common in patients with depression and those with memory problems.

There are many reasons for noncompliance. Often, patients believe treatment is no longer necessary once a problem has been corrected or when treating asymptomatic diseases, such as high blood pressure, elevated cholesterol or coronary artery disease. This is especially true if the medications have adverse side effects.

I recently saw a patient who had a heart attack and was taking metoprolol, a beta blocker proven to reduce the risk of heart attack, and Vytorin, a combination of two cholesterol-lowering agents. While taking these two drugs, the patient felt lethargic and had decreased libido — all well-recognized side effects of metoprolol. Rather than consulting his physician, he decided to discontinue both medications.

While the side effects from metoprolol disappeared and he felt wonderful, discontinuing Vytorin led to a dangerously high cholesterol level and an unacceptable increased risk of a second heart attack. Had this patient spoken to his physician, an alternate plan would have been possible.

Some patients elect not to take medications because of potential side effects before even starting the therapy. Even worse, patients may abruptly stop treatment because a report appears in the media describing the drug to be either ineffective or dangerous. Every drug comes with side effects and even very rare complications are reported.

Doubt and distrust can also be major factors for noncompliance. Patients who do not have a trusting relationship with their physician are much more likely to discontinue medications. Moreover, if patients question the treatment or doubt its effectiveness, they usually fail to adhere to the prescription guidelines, keep appointments or refill prescriptions.

The financial burden of medications often influences a patient's decision to stop using a drug or to take it less frequently.

Toward the end of the year, many older patients on several expensive medications are forced to make tough financial choices when they reach the "doughnut hole," or the point at which Medicare has paid out $2,500 and stops covering the cost of medication. The more medications taken, the more expensive the drugs, and the more complex the schedule (such as taking drugs three or four times daily) — these all contribute significantly to noncompliance.

Health care providers must play a more active role in assuring compliance, particularly the physician and the pharmacist. Patients must truly understand the critical reason and value of the treatment. And whenever possible, generic medications should be prescribed to minimize cost. Patient education on side effects and what to expect taking specific medications should be a mandatory component of any medical exam or prescription.

Since no physician can be fully aware of all the adverse effects of medications, it's important that patients be empowered to research their medication and become knowledgeable about the drug. A good pharmacist is an excellent resource to educate patients on how to interpret the risk of developing a side effect. And a pharmacist can provide assurance that the benefits far outweigh the risks. In addition, pharmacists can offer a second line of defense to help patients who are at high risk of noncompliance. When necessary, any concerned health care provider should elicit the help of family members or friends in monitoring medication usage.

Most importantly, patients and their families should never spontaneously discontinue treatment. Call your physician and discuss problems that could be ascribed to medications. If costs are a concern, let your physician know and try to develop an alternate plan that will be more easily followed. If you or someone you know is having concerns about treatment, consult your physician and rely on your team of providers. Making unilateral decisions about when to start and stop a drug can lead to disastrous consequences.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.