By Dr. Beth Hodges
Medication nonadherence is not solely a problem of modern civilization. Hippocrates may have said it best, “Keep a watch on the faults of the patients, which often make them lie about the taking of things prescribed. For through not taking…they sometimes die.”
Now, most of us who miss a dose of prescribed medication don’t do it to intentionally lie, and even fewer of us miss a dose with the intent of dying. The fact is, Americans do not, in general, do a good job of taking their medication. Studies show people miss doses of needed medication as much as 50% of the time and 25% of all new prescriptions are never even filled. At least 13% of all hospitalizations and emergency room visits and about 125,000 deaths each year could be avoided if patients took their prescribed medications as directed. The total cost of medication nonadherence adds up to $300 billion a year.
Former Surgeon General C. Everett Koop said, “Drugs don’t work in patients who don’t take them.”
It’s simple—when people don’t take their prescribed medications as directed emergency room visits increase, hospitalizations increase, and people die.
With such serious possible consequences, why would people ever skip taking their medication? There are lots of reasons, but it’s easier to break them into two categories—unintentional and intentional.
Unintentional reasons are easiest to fix. If patients chronically forget to take their medication, encourage them to set an alarm or reminder on their phone or alarm clock. If possible, change the dosing time so it’s more convenient, such as with other medications or as part of a morning/evening routine. Recommend that they keep their medication bottles in a prominent place, like next to the coffee pot, and to carry one extra dose in their purse or wallet in case they forget before leaving the house. Using a weekly medication dose planner is also helpful for patients who can’t remember later if they took their medication already for the day. Confusion can be another barrier. If it’s obvious during a visit that your patient isn’t sure what medications they take and when, schedule a time for them to bring their pill bottles and meet with a nurse (CPT 99411) to review the medications and reconcile them to the list you have in your EHR. Home health can also send a nurse out to the house for a medication review.
Intentional reasons to miss medications are usually due to mistrust, side effects, cost, fear, or lack of desire or belief in benefit. Whatever the reason, encourage your patient to discuss the issue openly. You can’t help if you don’t know their concerns.
Also make sure you encourage your patients to let you know of any over the counter or herbal/alternative medications they take, as there can sometimes be serious interactions between these and prescription medications.
Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.