Non-Compliance: America’s “Other” Drug Problem

When thinking about drug problems in the US, illegal drug use or abuse of prescription drugs usually comes to mind. We probably think of non-compliance in our prescription drug regimen less often. But because non-adherence to drug treatment plans results in around 125,000 deaths and costs the healthcare system some $177 billion every year, it can be properly thought of as America’s “other” drug problem. For some time now pharmacists have been playing a larger role in our health care than they once did. While the physician may once have been the only one responsible for making sure drugs were taken correctly and on time, today’s “pharmacists are the medication experts and are specifically trained to help consumers with their medication issues and questions, including adherence.” Thomas Menighan, CEO of the American Pharmacists Association, also says that “pharmacists can help coordinate a better medication schedule and is available to discuss proper medication usage, food/drug interactions, side effects, dosing, generics and over-the-counter medications, compliance issues and more.”

Symptoms of taking medications incorrectly may not be noticeable or be as minor as a small headache and fatigue, yet may drastically alter the effectiveness of treatment and possibly be life-threatening. For example, patients with cardiovascular problems who do not adhere to their medications are at increased risk for stroke, heart attack and other cardiac conditions. In diabetics, improper adherence to medications and treatments can lead to debilitating complications such as increased blood sugar, amputations, blindness, kidney disease, cardiovascular disease and stroke. There can be many reasons people don’t take their medication as prescribed but because our healthcare model is changing, pharmacists are in a perfect position to take a more active role in alleviating this problem. Education and follow-up are key when consumers choose not to take a medication because they don’t believe in its value or its helpfulness or don’t take a prescription regularly because they don’t have a full understanding of the medication or the routine.

In a recent Harvard Medical School study, more than 20% of first time prescriptions went unfilled. Primary nonadherence, or the failure to fill a first prescription, was even higher among patients with chronic diseases – diabetes 31.4% and hypertension 28.4%. Any healthcare provider will tell you that medications don’t work in people who don’t take them. But since pharmacists also offer basic healthcare services such as blood pressure screenings and immunizations, education and compliance monitoring would seem to be a logical extension of the pharmacist’s responsibilities. In addition to the standard query, “Do you have any questions about this drug?” and the written instructions that are routinely given with each prescription, discussions regarding compliance should be customary. It’s common that physicians don’t do much drug education or follow-up with patients regarding how medicines are taken, how they work or how a patient feels once a regimen is undertaken. Making such discussions comfortable and convenient will go a long way towards improving the damage non-compliance does to our personal health and to our national healthcare budget.

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