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by Stahl RJ

Medication Non-Adherence and Chronic Conditions

Image for arixtra Chronic diseases, like heart disease, cancer, stroke, and diabetes are far more common today than infectious diseases. Chronic diseases usually need to be managed over a long period of time. In many cases, chronic diseases are incurable. Long-term prescription medications to reduce or control symptoms are usually the course of treatment.
Medication non-adherence is when you do not take medication as prescribed. Some examples of this include:
  • Not filling the prescription
  • Not getting refills
  • Taking a different dose than prescribed
  • Not taking the medication as often as you should

What Are the Consequences?

Unfortunately, statistics show that a low percentage of Americans with chronic conditions take their medications as prescribed.
This can result in serious consequences. For example, your condition could worsen, leading to more intense treatment, more medications, and even hospitalization. Medication non-adherence can also be a financial burden since it may cause you tomiss work, have more doctor appointments and more costly prescriptions. In extreme cases, not taking your medication can lead to a heart attack, stroke, or even death.

What Are the Reasons for Non-Adherence? What Can You Do?

There are many reasons why people do not take their medications. Here are some common reasons and ways to counter these concerns.

I do not understand how to take the medication.

Make an appointment to talk to your doctor. Write down any questions you have. Make sure you are clear about:
  • The dose—How much medication do you need to take at one time?
  • The daily schedule—How many times during the day do you need to take the medication?
  • The duration—How long do you need to continue taking it?
  • Steps to take if you miss a dose—Do you need to take the medication as soon as possible or should you wait until the next day?
  • Special instructions—For example, should you take the medication with food?
Your pharmacist is another resource. Don't be shy when it comes to asking questions about your medication, possible drug interactions, and side effects. Don't be afraid to write the instructions down.

I am afraid of the side effects.

Remember to tell all your doctors about all the medications you are taking, especially if you see more than one doctor. It is also important for them to know if you are taking any supplements or herbal medications.Your doctor can explain which side effects are common and what you should do if you have any problems. In some cases a doctor can consider another medication with different side effects that may be more acceptable.
When you get home from the pharmacy, take some time to read the paperwork that comes with the prescription. The most common side effects are generally listed first. Keep in mind that some of the side effects listed occurred in a very small number of people, and that no one has all the side effects. In most cases, your body will adjust to them in a short amount of time and they won't even be noticeable. Knowing the potential side effects and how to handle them can help ease your fears.

The medication is too expensive.

Before you decide not to take the medication because it is too costly, explore your options:
  • Ask your doctor or pharmacist if you can use a less expensive generic drug. Many states require pharmacists to dispense generic drugs unless otherwise specified.
  • If you have prescription drug coverage, contact your insurance company to find out which drugs are covered under your plan.
  • Learn about patient assistance programs. If you are eligible, you may be able to get your medication at a lower cost. You can find more information online or through your pharmacist.

I feel fine. Why do I need to keep taking the medication?

Some conditions, such as high blood pressure, do not have symptoms that you notice, but that does not mean your health is fine. In other cases, the symptoms go away because of the medication and if you were to stop taking it, your symptoms would return.
If you are not sure how the medication works in your body or why you are taking it, talk to your doctor. It is important to understand the purpose of the medication and what could happen if the condition goes untreated.
Untreated chronic diseases can often lead to serious health complications. Keep in mind that you may feel well because your medications are working.

It is hard to remember to take my medication!

There are a number of strategies to try:
  • If you own a smartphone, there are several apps to choose from. Some will even remind you when it is time to refill your prescription. While you're virtual shopping in your app store, look to see if your drug store or pharmacy has an app.
  • Other technologies include talking alarm clocks, watches, and timers that have a section to hold pills.
  • If you take a lot of medications, and prefer to use paper and a pen, create a chart. List the names of the medications, the dosages, and the time of day when you need to take them.
  • Have a set routine, like taking your medication when you make coffee in the morning.
  • Use a pill organizer. This is a plastic container that has a section for each day of the week.
  • Let your family members or friends know when you have to take a pill so they can remind you in case you forget.
  • Check with your pharmacy to see if they will automatically refill your prescription, then contact you by phone or text message when it is ready for pick up. This is also a great time saver and eliminates waiting at the pharmacy for a refill.
  • If you have to take a lot of medications each day, talk to your doctor. New treatment regimens become available all the time. Maybe a pill you have been taking three times a day can now be taken once a day or some of your medicines now come in a combination pill.
If you are facing challenges when it comes to taking your medication, get help from your doctor and pharmacist. The steps that you take now to care for your chronic condition can have a huge impact on the rest of your life.

RESOURCES

Educate Before You Medicate
http://www.talkaboutrx.org
Take Control of Your Health
http://www.tcyh.org

CANADIAN RESOURCES

Canadian Pharmacists Association
http://www.pharmacists.ca
Health Canada
http://www.hc-sc.gc.ca

References

Bosworth H. Medication adherence: making the case for increased awareness. Script Your Future website. Available at: http://scriptyourfuture.org/wp-content/themes/cons/m/Script%5FYour%5FFuture%5FBriefing%5FPaper.pdf. Accessed October 18, 2013.
Chronic diseases. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm. Updated December 17, 2009. Accessed October 18, 2013.
Gray R, White J, Schulz M, Abderhalden C. Enhancing medication adherence in people with schizophrenia: an international programme of research. Int J Ment Health Nurs. 2010;19(1):36-44.
National Council on Patient Information and Education. Enhancing prescription medicine adherence: a national action plan. Educate Before You Medicate website. Available at: http://www.talkaboutrx.org/documents/enhancing%5Fprescription%5Fmedicine%5Fadherence.pdf. Published August 2007. Accessed October 18, 2013.
Osterber L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
Take control of your medicines. Take Control of Your Health website. Available at: http://www.tcyh.org/medications/medications.shtml. Accessed October 18, 2013.

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