After you write that prescription (or email it to your patient’s pharmacist), do you follow up with the patient to make sure that they’re actually taking it and not missing any doses? How can you be sure that they’re really following their medication regimen and not just telling you they are for “brownie points”?
The sad fact is that many patients don’t take ongoing medication as prescribed, and a large number of the ones who say they do aren’t telling you the truth. “Medication compliance runs around 40 to 50 percent at best, and many studies show results of only 30 percent or so,” says Maura Conry, a pharmacist, psychotherapist and social worker with Pharmacy & Social Work in Shawnee Mission, Kan.
Consider that one-third of patients do not fill their first prescription, and of those who do, only 50 percent continue refilling it six months later, according to Andrew M. Peterson, a pharmacist and dean of Mayes College of Healthcare Business and Policy at the University of the Sciences in Philadelphia. “And often times, patients typically do not tell their physician that they stopped taking their medication until either the next visit or an adverse event occurs.”
Patients who fib about their Rx compliance aren’t necessarily liars – they just want to please you because they see you as important and they don’t want to let you down. But patient non-adherence results in unnecessary illness, increased hospital admissions, increased hospital admissions, increased healthcare costs and even deaths, says Janice Anderson, director of pharmacy programs with URAC, a non-profit organization in Washington, D.C., that deals with healthcare accreditation, education and measurement.
How to increase compliance
There are many reasons why Rx compliance is so low. Among them are financial issues, fear of side effects, an undisciplined lifestyle, difficulty swallowing pills, mental illness, emotional issues and disapproval of treatment by patients’ friends and family. Forgetfulness and lack of efficacy are also contributing factors.
As their physician, you need to be aware of these issues – and any other barriers to Rx compliance your patients are facing – and address them in order to increase the odds of patients following through.
“The most important way to improve patient compliance is to educate the patient as to how the medication is going to improve their health,” says Laura Carinci, M.D., a women’s health specialist with South Nassau Primary Care in Bellmore, N.Y.
When prescribing medication, explain what it is being used for, what the patient can expect in terms of effectiveness and potential side effects, how to manage any side effects that may occur, what to do if they miss a dose and what other things they can do to ensure optimal effectiveness of the medication, says David Calabrese, R.Ph, vice president of clinical operations at SXC Health Solutions in Lisle, Ill.
Make sure patients understand that the small chance of any potential side effect is outweighed by the benefits to their health, Carinci says. Taking the time to explain this can prevent problems later. In addition, ask them about their routines and discuss the most optimal time for them to take their meds.
It’s also important to get an honest report on compliance for each patient. Conry recommends saying to the patient, “Most of my patients do not take all of their medications regularly and accurately. It is important to me to know exactly how many doses you are actually taking every day. That way, we can work together to be sure you get the right dose, and I can better help you.”
Make compliance a priority when speaking with patients. “Ask questions such as, ‘How many pills have you missed in the last week?’ ” says Sarah L. Scarpace, a pharmacist and assistant dean and associate professor at Albany College of Pharmacy and Health Sciences in Albany, N.Y. “If you begin the discussion with the expectation that the patient has not been perfect, they are sometimes more likely to tell you the truth.”
If cost is an issue, try to substitute a less-expensive alternative, and work with their insurance company to find an affordable solution.
Another suggestion is to collaborate with the rest of the patient’s healthcare team (pharmacists, nurses, etc.) to encourage compliance and discover any problems with medication compliance early on. “Pharmacists are key providers of medication information and see the patient on a regular basis between physician visits,” points out Peterson. “They can greatly assist in maintaining or improving medication adherence.” (See MOT’s article “7 Reasons to Build Relationships with Local Pharmacists”)
Lubna Somjee, Ph.D., a clinical and health psychologist in Poughkeepsie, N.Y., recommends formulating a detailed Rx compliance plan for each patient, which could include something as simple as education and/or monitoring or checking-in with them – enlist the patient’s support system to help with this. You might help them simplify dosing by using pill boxes or utilizing electronic reminders.
More complex cases may necessitate bringing in a health psychologist to employ psychosocial strategies. (See MOT’s article “Supporting Your Patients Outside Your Office”)
Encourage routine follow-ups, checkups and blood work so that you can continue to monitor the progression or stability of the disease and make any necessary changes, says Pedro Aquino, M.D., and internist and family medicine practitioner, assistant professor of family and community medicine at The University of Texas Health Science Center at Houston (UTHealth) Medical School and a member of the medical staff of Lyndon B. Johnson General Hospital in Houston.
Finally, don’t forget to reward compliance by pointing out how patients’ health has improved since taking their medication regularly. This will remind them to stick with their regimen.