Half of Heart Patients Don’t Take Their Meds; Probably a System Related Cause
Non-compliance of patients with their prescribed drugs has been a longstanding problem. Pharmaceutical companies have a large stake in this issue and have developed iPhone apps to help ensure having patients take their meds (see: Big Pharma Develops Smartphone Apps to Achieve Multiple Goals). A recent article discussed the degree of non-compliance for patients with heart disease (see: Half of heart patients don't stick to their meds):
Just half of people who are given a prescription to prevent heart disease continue to get their medications refilled over time, according to a new review of several studies. And among people who have already had a heart attack, one out of every three fails to continue getting their prescription refilled....The researchers collected the results from 20 studies that suggested the rate at which people continue taking the drugs ranges from 30 to 80 percent. The studies looked at seven medications, including aspirin, blood pressure drugs, and cholesterol-lowering statins, typically intended for life-long use....Despite it being commonly understood that patients don't always follow the doctors' orders, [the lead author] said there are few interventions known to consistently help patients stay on track with their medications. That's because it's not entirely clear why patients don't stick to their prescriptions, he said. In some cases, it could be related to the patient - difficulty reading the drug label or opening the container, fear of side effects, or challenges making it to the pharmacy for a refill. The health care system could play a role too. "It's difficult to have a real discourse with a physician because...everybody's busy." ...."Because of the system and the constraints on cost and time, I think what you end up with are people who are really inadequately prepared" to follow through with their prescriptions. For the most part, patients complied with their prescriptions at about the same level for each of the different types of drugs.... "It's probably system-related factors that are so important that they dwarf these little tolerability issues. They get drowned out by the way prescriptions are given and the time we have to engage with people," he said. He said he thinks that frequent follow-ups with patients to make sure they're continuing their medication is important to help people stay on track. "It reflects buy-in from patients and prescribers that indeed this is an important thing," ....
This article helped to clear up a nagging concern that I have previously had. My hunch was that most of the drug non-compliance was based on their high cost or patients' desire to avoid real or perceived drug side effects. I am sure that such issues come into play but I want to focus here on what the researchers in the above article refer to as "system-related factors." I believe that the majority of patients want to get better and prescribed drugs are an essential part of this goal. Why would they not take their meds unless they were confused about their value in getting well?
Think about the common scenario whereby a physician writes a script for a patient. It's usually at the end of a visit. The physician generates the script and then says, in effect: Take these pills. They will help you. Sometimes there is a cursory reference by the physician to potential side effects. I can understand why there may be non-compliance in such circumstances with no real patient buy-in. So how do you enable such a buy-in? For me, the answer for many "tentative" patients may be a mini-counseling session following the doctor's appointment with a nurse carefully discussing factors that may be bothering or confusing the patient. I feel sure that such attention will result in greater patient buy-in to the process.