Cost for sure is one of the top factors influencing medication compliance (adherence) among patients in the United States. But from experience working in the healthcare field with clinical professionals like RN Care Managers, data indicates that there are many other reasons for this non-compliance.
Many survey results conducted among patients show that because fear of possible embarrassment, being chastised, or seeming to be ungrateful for a doctor's care, they did not admit to being uncompliant to their drug treatment. Here is a list of other reasons from those surveys:
• Forgot to take their meds
• Did not pick up their prescription from the pharmacy
• Purpose of treatment was not clear
• Perceived lack of effect
• Real or perceived side-effects but did not tell doctor
• Instructions for administration were not clear
• Physical difficulty in complying (e.g. opening medicine containers, handling small tablets, swallowing difficulties, travel to place of treatment)
• Unpleasant taste
. Complicated regimen when other meds have to be taken too
• Cost of drugs
Our team of nurses would discuss these results and validate them with annecdotal stories. For those patients taking multiple drugs from multiple physicians for example, it is true that little education is provided on possible contraindications, side effects etc. Either the patient did not tell the doctor the meds he/she was taking or the doctor failed to acknowledge this information. If medication X causes "forgetfulness" the patient could also forget to take the other pills. For other patients, the side effects were so bad that on their own would cut the dosage in half.
The national efforts to regain control of medication cost (for the payors and patients) include a more aggressive push for Generic drugs as a top government agenda which may also include a Universal Model of healthcare. But in my opinion, the crisis in our healthcare system is also on the ever growing need for treating many conditions with drugs instead of focusing on more natural approaches to wellness that would allow the body to return to optimal functioning using the inherent self healing ability of our physiology which has been validated by many studies in the field of medicine.
Studies have also shown that non-compliance causes 125,000 deaths annually in the US (2), leads to 10 to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. It is, in the words of The New York Times (1) the world’s "other drug problem".
Negative Economic Effects of Non-Compliance
· 23% of nursing home admissions due to noncompliance(3). Cost $31.3 billion / 380,000 patients.
· 10% of hospital admissions due to noncompliance (4,5). Cost $15.2 billion / 3.5 million patients.
Prescriptions
· About 50% of the 2 billion prescriptions filled each year are not taken correctly.
· 1/3 of patients take all their medicine, 1/3 take some, 1/3 don't take any at all (Rx prescription never filled)
We are among the highest users of prescription drugs in the world but are still among the sickest most technologically advanced societies. Our healthcare system will not be able to sustain much longer its financial infrastructure even if the economy gets better! We have been in crisis for a while now. Medicare and other payors will not be able to keep up and the uninsured numbers will continue to increase. We need a new approach to HEALTHCARE one where the outcome is health and wellness instead of a never ending drug-centric model.
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Cost for sure is one of the top factors influencing medication compliance (adherence) among patients in the United States. But from experience working in the healthcare field with clinical professionals like RN Care Managers, data indicates that there are many other reasons for this non-compliance.
Many survey results conducted among patients show that because fear of possible embarrassment, being chastised, or seeming to be ungrateful for a doctor's care, they did not admit to being uncompliant to their drug treatment. Here is a list of other reasons from those surveys:
• Forgot to take their meds
• Did not pick up their prescription from the pharmacy
• Purpose of treatment was not clear
• Perceived lack of effect
• Real or perceived side-effects but did not tell doctor
• Instructions for administration were not clear
• Physical difficulty in complying (e.g. opening medicine containers, handling small tablets, swallowing difficulties, travel to place of treatment)
• Unpleasant taste
. Complicated regimen when other meds have to be taken too
• Cost of drugs
Our team of nurses would discuss these results and validate them with annecdotal stories. For those patients taking multiple drugs from multiple physicians for example, it is true that little education is provided on possible contraindications, side effects etc. Either the patient did not tell the doctor the meds he/she was taking or the doctor failed to acknowledge this information. If medication X causes "forgetfulness" the patient could also forget to take the other pills. For other patients, the side effects were so bad that on their own would cut the dosage in half.
The national efforts to regain control of medication cost (for the payors and patients) include a more aggressive push for Generic drugs as a top government agenda which may also include a Universal Model of healthcare. But in my opinion, the crisis in our healthcare system is also on the ever growing need for treating many conditions with drugs instead of focusing on more natural approaches to wellness that would allow the body to return to optimal functioning using the inherent self healing ability of our physiology which has been validated by many studies in the field of medicine.
Studies have also shown that non-compliance causes 125,000 deaths annually in the US (2), leads to 10 to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. It is, in the words of The New York Times (1) the world’s "other drug problem".
Negative Economic Effects of Non-Compliance
· 23% of nursing home admissions due to noncompliance(3). Cost $31.3 billion / 380,000 patients.
· 10% of hospital admissions due to noncompliance (4,5). Cost $15.2 billion / 3.5 million patients.
Prescriptions
· About 50% of the 2 billion prescriptions filled each year are not taken correctly.
· 1/3 of patients take all their medicine, 1/3 take some, 1/3 don't take any at all (Rx prescription never filled)
http://www.usatoday.com/news/health/2008-02-08-prescription-chart_N.htm
http://www.drugfree.org/Portal/DrugIssue/Features/Prescription_Medicine_Misuse
We are among the highest users of prescription drugs in the world but are still among the sickest most technologically advanced societies. Our healthcare system will not be able to sustain much longer its financial infrastructure even if the economy gets better! We have been in crisis for a while now. Medicare and other payors will not be able to keep up and the uninsured numbers will continue to increase. We need a new approach to HEALTHCARE one where the outcome is health and wellness instead of a never ending drug-centric model.
December 6, 2008 - 10:12pmThis Comment
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