October 20, 2018
Taking Your Medicine
Be Well

Taking Your Medicine

by John Swartzberg, M.D.

All medications have potential side effects, and it’s inevitable that some people will be harmed by them, no matter how careful they and their health care providers are. But there’s another big problem with medication that is completely avoidable: noncompliance. That is, many people don’t take their drugs properly (alter or skip doses, for instance, or stop too soon) or don’t take them at all, even for life-threatening diseases.

No one knows exactly how many people misuse medication, but I recently read these statistics in a review article from the Agency for Healthcare Research and Quality (AHRQ) in Annals of Internal Medicine:

  • About half of all medications for chronic diseases are not taken correctly and thus may fail to produce the desired results.
  • About 20 to 30 percent of prescriptions are never even filled (sometimes due to the expense).
  • Improper use of medication kills 125,000 Americans each year and leads to about 10 percent of all hospitalizations.
  • Such noncompliance costs the health care system as much as $290 billion annually.

A drug is less likely to be used correctly if it’s taken for long periods or taken with many other drugs—especially if it’s for a condition (such as hypertension or high cholesterol) that causes no obvious symptoms.

Why don’t people stick to drug regimens? Confusing instructions, a language barrier and/or poor memory often play a role. Many people worry about known side effects or unknown long-term risks. Some doubt the need for treatment or start to feel better, so they go off drugs (such as antibiotics) that are still necessary. Lack of “continuity of care”—resulting from having to change health care providers often or having multiple providers—increases the risk of improper use of medications. Even a change in a pill’s appearance can cause some people to stop taking a drug.

Last but not least, many people can’t afford their drugs. Americans are two to three times more likely to report that cost prevents them from taking medications than Canadians, even if they have health insurance (copays and deductibles can still be high), according to the AHRQ review. There is “robust evidence that reduced out-of-pocket expenses improve medication adherence across clinical conditions,” it concluded.

Poor adherence represents a failure of the medical system, as much as of the patients. Research shows that better counseling, clearly written instructions and automated phone or email reminders can improve matters. Health care providers and pharmacists need to communicate better with patients. People are more likely to follow instructions when their providers seem to care and take time to explain what is going on. But I know from my own experience when I was in practice that it’s often hard to know if patients really understand how to take their drugs.

If you get new medication, write down what your health care provider tells you about it. Double check with the pharmacist. Don’t hesitate to ask questions. If your regimen is confusing, a sectioned pill box can be a big help. If you’re on a drug for a chronic condition—especially if you take several—check periodically with your health care provider about whether you are taking it correctly.