Why don’t people take their pills?

MARK JOHANNIGMAN, Blanchard Valley Health System’s corporate director of pharmacy services and supply chain, said while being overmedicated might be a concern, being “undertreated” or undiagnosed is “a much bigger issue.” It can also be dangerous to stop taking a medication abruptly, he said. (Photo by Randy Roberts)


Be honest: Do you take all your medications as prescribed?

A lot of people don’t. Some don’t fill the prescription at all. But while it’s fairly common, it’s also dangerous.

University of Findlay College of Pharmacy professor of pharmaceutical sciences Mike Milks said even when he was a pharmacy student in the 1970s, his professors were discussing the need to get people to take their medications, so fewer would end up hospitalized or in urgent care.

More recently, Milks found a survey of why patients don’t take their medications. Twenty-four percent of respondents said it was because of forgetfulness, 20 percent because of perceived side effects, 17 percent because of the high drug cost and 14 percent because they thought it would have little effect or doubted it was necessary.

“Nonadherence” to prescribed medications, as health care professionals call it, costs between $100 billion and $300 billion of avoidable health care costs annually, or 3 percent to 10 percent of total health care costs in the United States, according to a 2014 paper in Risk Management and Healthcare Policy. Lost productivity costs are estimated at more than twice this, as patients don’t go to work or don’t work as effectively.

“That’s a lot of money,” Milks said.

The paper also states that an estimated 10 percent of hospitalizations in older adults may be caused by not adhering to medications. Nonadherence rates range from 25 percent to 50 percent, depending on the disease, patient characteristics and insurance coverage, it states.

The New York Times reported earlier this year that about 20 to 30 percent of prescriptions are never filled.

A doctor may assume their patient has filled a prescription. But since the doctor sends the prescription electronically now, rather than handing it to the patient, sometimes the patient isn’t even aware the drugs are waiting for them, said Ryan Schneider, chairman and associate professor of pharmaceutical sciences at the University of Findlay’s College of Pharmacy.

“Miscommunication happens,” said Schneider, who is also president-elect of the Ohio Pharmacists Association and a part-time community pharmacist in Pandora.

Medical professionals also need to examine the situation, including whether the medications are managing the patient’s symptoms. It shouldn’t be just, “Here are your drugs, take ’em like you’re supposed to,” Milks said.

Obstacles to better health

Sticker shock is a major obstacle.

Schneider said the doctor, upon prescribing a drug, won’t necessarily know it’s not on the health insurance plan formulary. When the patient gets to the pharmacy and finds out it will cost hundreds of dollars to fill, the pharmacist may just tell them to call their insurance company. Instead, the pharmacist could work with the patient to contact the physician about similar medications to substitute, Schneider said.

Also, some drug manufacturers have programs that provide medications to those who can’t afford them.

Milks said paying for medications now also means saving medical costs down the line — such as not having to pay for hospitalizations.

If you’re choosing not to take a medication, for whatever reason, be honest with the person prescribing it, he said. If your doctor assumes you’re taking a drug, and you’re not, they need to know that.

Blanchard Valley Health System’s corporate director of pharmacy services and supply chain, Mark Johannigman, said while being overmedicated might be a concern, being “undertreated” or undiagnosed is “a much bigger issue.”

A lot of parents don’t want their children taking too many medications, Milks said. But medications — like vaccines — are among the more cost-effective ways to treat and prevent health problems.

Many people also “distrust big business, Big Pharma,” Milks said. Some of this is “probably warranted” — but doesn’t mean you should distrust science itself. If a study shows taking certain medications after a heart attack can prevent a second heart attack and allow you live a decade or more longer: “The data is profound,” Milks said.

One medication survivors of heart attacks are supposed to take is baby aspirin. Milks said it’s easy to think it’s no big deal or to ask yourself: “What good could a baby aspirin do?” Yet it’s shown to substantially decrease the risk of a second heart attack.

If someone with HIV doesn’t take their medications, they’re more likely to develop full-blown AIDS, which can be life-threatening. They’ll also have a higher viral load, which not only increases the chances they will have complications, but also makes it more likely that they will spread the virus to others, Milks said.

Psychiatric drugs, too, may have side effects, but patients who do not take their medications could end up harming themselves or others, Schneider said.

It might take trial and error to find the right medication. And some drugs take several weeks to reach full effect, so a patient may have to try several before finding the one that works for them, which means “patients can become demoralized,” Schneider said.

Often, too, patients don’t want to take their medications because they simply don’t feel sick. But just because you don’t feel symptoms doesn’t mean nothing is wrong. High cholesterol, for example, puts you at risk of heart attack or stroke. You’re not going to feel any different if you take the medicine than if you don’t, Schneider said. The only way to know is to get blood work done.

A “lack of perceived benefit” to the patient may keep them from taking the drug, Johannigman said. High blood pressure is another condition where patients may have no symptoms.

Untreated high blood pressure can create long-term damage to kidneys and other organs, and increases the risk of heart attack and stroke, Schneider said.

Side effects and dosages

A lot of patients have what medical professionals call “comorbidities” — that is, multiple issues at once, like diabetes, high blood pressure and high cholesterol. But if they’re taking, say, four different medications, or even eight, they’re more likely to have side effects, or to not take the drugs as prescribed, Schneider said.

And some medications aren’t taken every day but, say, once a week, so patients need to keep track of that.

“The complexity of the regimen” affects whether patients stick to it, Schneider said, adding there are smartphone apps that will remind you when it’s time to take your pills.

Side effects are also a concern. Schneider used one of the more common type 2 diabetes drugs, metformin, as an example. If you don’t start with a low dose, and take it with food, you can experience severe gastrointestinal issues and diarrhea. Those who do start with a low dose find their body becomes accustomed to it, so a doctor who starts with too high a dose might “scare away the patient,” Schneider said.

Johannigman said side effects for many drugs are short-lived, and if you stick it out for a few weeks your body adjusts. Also, side effects might be specific to one medication, and switching to a similar one may make a difference, he said.

Schneider said some patients get nervous about potential side effects before even taking the drug, after reading “every word of that packet” that lists all sorts of potential concerns.

Schneider said many of those listed are actually very rare.

When you don’t take your medication, “A lot of times you won’t see the outcome until years down the road,” Johannigman said. He warned that patients are regularly hospitalized for health consequences related to not taking medications as prescribed.

Johannigman said it can also be dangerous to stop taking a medication abruptly, as “some medications need to be weaned off.”

Schneider said doctors and dentists can change this trend by educating patients before they leave their building — reminding them which are refills and which are new medications, and what to expect when taking the drugs. And pharmacists can help by counseling patients with every medication and refill.

Going to the pharmacy when it’s less busy may mean you’ll have more of an opportunity to talk with the pharmacist.

Regardless, when you pick up your prescriptions and they ask “Do you have any questions for the pharmacist?” it’s OK to say yes, Schneider said.

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