Saturday, May 21, 2011
Why do patients stop taking their medications?
Lots of smart people over the years have been trying to figure out why people stop taking their medications within the first 12 months. Within the first 12-months of starting a new prescription, patient compliance rates drop to less than 50%. This rate is even lower for people with multiple chronic conditions taking one or more prescription medications.
If these medications are so important to patients, why do they just stop taking them? It defies common sense. Sure issues like medication cost, forgetfulness, lack of symptoms, and psychosocial issues like depression play a role in patient non-compliance. But there also something else going on ... or in this case not going on.
The problem is that doctors and patients simply don't talk much about new medications once prescribed. Here's what I mean. Let's say that at a routine check-up a physician tells a patient that he/she wants to put them on a medication to help them control their cholesterol. The doctor spends about 50 seconds telling the patient about the medication. The patient nods their head takes the prescription and boom, the visit is over.
Let's say the patient actually gets the prescription filled. For some people that is a leap of faith considering the likely chain of events up to that moment:
--The physician didn't really make a good case for why they needed the medication. If the doctor wanted me to take it he/she should have been emphatic about it, as in "I recommend you take this," not the simple "I want to try something", or to describe what it would do or what would happen if the patient didn't take it.
--The doctor didn't mention how the new medication would interact with the two other pills I am already taking.
--Consequentially, the patient may not believe they really need the medication.
Fast forward 12 months. The patient has been back to see the same doctor twice for problem unrelated to cholesterol. At neither of these appointments did the doctor mentioned or ask how the patient was doing with the new medication. The doctor did mention the need for a blood test to check for liver issues and that they should recheck the cholesterol levels at the next visit.
So at this point the patient concludes the following about the new medication:
--The doctor never talks about cholesterol or brings up the subject of the medication. I assume I am taking it correctly.
--If the doctor doesn't mention it (the medication) it must not be important.
--I haven't notice any difference in my health. I guess I don't need the medication.
Sure, the patient should have asked their doctor if they had any questions about the new medication. But patients seldom ask their doctor questions. Sure they could ask the pharmacist ... but the pharmacist would tell them to just ask their doctor.
It's so much easier for the patient to just not refill the prescription.
We have all heard the expression that whatever doesn't get measured doesn't get done. Well the same thing is true for when it comes to physician-patient communications. Whatever issues doctors don't talk with patients about will not get done over the long haul either. In this case patients simply stop taking prescribed medications.
As primary care slowly shifts from episodic, acute care to continuous care with the aid of electronic medical records and the focus of patient-centered care, things should get better with respect to patient compliance. It needs to. Give the current focus on episodic acute care too many chronic health issues simply are not being addressed for one visit to the next.
That's what I think. What's your opinion?
This post by Steven Wilkins, MPH, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
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