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Why you should take medication as prescribed

An estimated 125,000 deaths each year result from not adhering to drug regimens

Taking medication when you need it is an important part of protecting your health and managing chronic conditions. Medication adherence statistics, however, are sobering. Studies show that around 20% to 30% of prescriptions are never filled, and approximately 50% of medications for chronic disease are not taken as prescribed. 

That can be dangerous. Failure to follow medication regimens is estimated to cause approximately 125,000 deaths each year and is responsible for at least 10% of hospital admissions in the United States. In addition, it puts a big strain on the healthcare system, costing between $100 and $289 billion annually. So, what does medication adherence really mean? Why is it important? And how can patients ensure they are taking their Rx as they should? 

What is medication adherence?

Medication adherence and compliance are two terms used to describe the extent to which patients refill their medication on time, take their medication as prescribed, as well as whether or not they continue to take a prescribed medication. There are many factors that contribute to medication adherence and compliance, such as remembering to fill a prescription, taking a medication at the right time, and remembering to follow all instructions regarding the medication. 

“A patient is considered adherent if they take 80% of their prescribed medicine(s),” according to the American Medical Association. Taking any less than 80% of your medication means you are nonadherent.

For long-term therapies, the World Health Organization defines patient adherence as not only adhering to medication therapy but also making diet and lifestyle changes per the recommendations of a healthcare provider. For example, blood pressure control often requires more than taking an antihypertensive. It requires eating a heart-healthy diet, regular exercise, and stress management.

Why is medication adherence important?

The consequences of poor medication adherence can be dire and may include: 

  • Difficulty in optimizing medication and dosage: Your healthcare provider chooses your medication therapy and the dosage based on parameters they measure or witness. When deciding whether to adjust a dose or change a medication, it is difficult to make the best determination if you have not been taking your current therapy as prescribed. For example, your healthcare professional may ask you to take a 10mg tablet every day of a blood pressure medication for one month, and then return to the office for an evaluation of the effectiveness. If you only take the medication on average 4 out of every 7 days, the evaluation of the medication’s effectiveness for you in one month won’t be accurate or depict the medication’s true potential to treat your high blood pressure.
  • Disease progression: Disease progression refers to the way an illness affects a patient from the early stages to its peak, and finally to its resolution. “Many chronic illnesses are progressive, and medications may be available to slow that progression,” says Dr. Emmel. However, as many as 1 in 3 patients with a long-term health condition never initiate a newly prescribed medication, according to adherence rates published in The Pharmaceutical Journal. If an illness is not treated, the progression can not be slowed. 
  • Risk of life-threatening complications: “Some of the consequences—depending on the chronic illness—can include a higher risk of suffering a life-threatening complication,” Dr. Emmel warns. Dr. Roxanne agrees and offers this scenario as an example: “Many patients with high blood pressure present to the emergency room nationwide every day with end-organ damage that is often caused by their blood pressure being high from not taking their medications.”
  • More ER and hospital visits: Medication non-compliance can lead to trips to the emergency room and hospital visits, as well as avoidable healthcare costs. 

The good news is that these consequences can be avoided with good medication adherence, but what does that look like? 

Why patients don’t take their medication

Patient-related factors

The reasons behind medication nonadherence can be multifaceted. “Many patients have hidden reasons they are not adherent to their medications,” says Ashley Roxanne, DO, a resident physician in Atlanta. 

Beliefs and attitudes

Patients may be in denial about the seriousness of the condition their prescriber is trying to treat for them. Another issue affecting medication adherence may be a patient’s lack of trust that a medication will be helpful for them, especially if the benefits are not initially apparent. It can be difficult to sway a patient’s beliefs when the benefits are not immediate and physically obvious.

Cognitive functioning and memory

Cognitive function and memory can affect a patient’s ability to remember to take their medications every day. Luckily, there are many modern advancements to help overcome this hurdle. The simplest of these may be to use the weekly pill box organizers. This is a great way for family or caregivers to help the patient stay organized and be able to see if they have taken their medication. There are pill containers with alarms that will remind the patient to take their medication as well. While cognitive function can make it more challenging, medication adherence is still possible with the help of a few different tools available.

Socioeconomic status

The cost of medications can also be a big hurdle. “For a patient on a fixed income or working a minimum wage job,” Dr. Roxanne says, “sometimes the choice comes down to ‘Do I pay my electricity bill or do I get my prescriptions this week?’” Unfortunately, non-compliance has a cost too. Ultimately, untreated medical conditions lead to higher healthcare costs when treating more serious, uncontrolled conditions.

Complexity of treatment regimen

Typically, the more medications a patient must take at different times of the day, the more likely they are to miss a dose or take it incorrectly. There are other factors that may add to the complexity such as medications that must be taken on an empty stomach compared to those that must be taken with food. Some are less effective, or even dangerous if taken in the presence of certain foods. Treatment plans that call for administration during your working hours may present challenges, especially if you work in an environment where you can not have easy access to your medications. If you travel often, maintaining access to your medication can be challenging as well. Maintaining medication compliance and adherence requires a good deal of proactive planning on the patient’s part, especially for more complex regimens that have higher pill counts.

Side effects and drug interactions

“For many chronic diseases, medications don’t necessarily make patients feel any better,” says Aaron Emmel, Pharm.D., founder and program director of pharmacytechscholar.com. “A great example are statin medications: for those at risk, they can reduce the risk of a heart attack or a stroke. But this isn’t something that the patient feels, and they may even be experiencing side effects that are bothersome. This can make it hard to stay motivated to continue taking the medication.”

There are also situations where two distinct medications that you need for your overall health don’t play well with each other. Your healthcare professional may have to change one of the medications or have you take them at opposite times of the day to avoid these interactions. Certain foods can present challenges for medication effectiveness too. 

Healthcare situational factors

Provider-patient relationship

The patient’s relationship with the provider is a key component of their trust in the medication therapy chosen for them. When a patient feels that the provider has a personal and vested interest in their health, they tend to take their recommendations to heart. This is especially important when the provider is making lifestyle change recommendations such as weight loss or smoking cessation. Patients are more successful when there is a cadence of regular follow-up and support.

Access to healthcare providers and programs

While many patients may acknowledge they need help achieving their health goals, they don’t know where to start. For those who are insured, the insurance program often makes available a list of providers they have access to, as well as support programs for fitness, mental health, and other aspects of their well-being. Navigating these benefits can still be challenging for some as many of these benefits are accessible online, and computer access is not something every patient has. This can also be much more difficult for those who are underinsured or not insured at all. Even if they can locate the needed service, making payment arrangements can be the next big hurdle.

The reasons behind a patient choosing not to fill a prescription or take it as prescribed may be complex, but they don’t mitigate the consequences.

How to improve medication adherence

Medications are only helpful if you remember to fill them and take them as prescribed. Fortunately, there are some simple tips that can help you do just that. 

Simplifying treatments

It is important that your prescribers and pharmacists are aware of all of the medications you are taking. They will help make sure there are no duplications in therapy that can be unnecessary or even harmful. There are also many new medications which are “combination” drugs that combine 2 or more commonly used medications into one tablet, which simplifies your medication routine. This can have a positive impact on medication adherence.

Patient education

“My biggest recommendation for increasing medication adherence is to maintain an open dialogue with your healthcare provider,” Dr. Emmel advises. “Make sure that you are getting all of the information you need regarding your health conditions and the treatments that are being offered. If you have any concerns, or any barriers to accessing a medication, inform your provider.”

When you pick up your prescriptions, take advantage of the opportunity to be counseled by your pharmacist. They can help answer any questions you may have or clarify any misinformation you may have received about your medications. This is your free chance to ask any questions you have about your medications- take advantage! Pharmacists and your prescribers will also give you advice on how to properly take your medications. For example, should it be taken in the morning or evening? With or without food? Can I drink grapefruit juice when I take this medication? These are all important pieces of information you should know prior to starting your treatment as they affect clinical outcomes.

Medication reminder tools

There are so many tools available now to help you remember to take your medications. From simple “day of the week” pill boxes to machines that will sound an alarm and physically dispense medication needed at that time, there really is a solution for almost everyone. You can even download reminder apps to your phone to assist! One of the advantages of these tools is that it is a great way for concerned friends and family to get involved in your medication routines. Some apps and machines even let them remotely monitor your compliance.

Lifestyle and schedule changes

The key to being able to adjust to major changes in your schedules and routines is keeping your medications organized and picking up your refills from the pharmacy before you run out. This will make last-minute travel or changes in your work schedule easier to adapt to without affecting your medication adherence. If you experience a significant change that is difficult to adapt to, speak with your prescriber to see if it can be accommodated with a change in therapy to make things easier. Open communication with your healthcare team is always important!

Be honest

Trust between healthcare professionals and patients is crucial. When you’re honest with your healthcare provider about why you’re not taking your medication, your physician can work with you to find a solution. For example, if cost is a barrier, your doctor or pharmacist might be able to suggest a lower-cost alternative. Or, you can always search for a SingleCare coupon to save on your prescriptions. When you work closely with your healthcare team, it leads to better patient care and health outcomes. 

RELATED: 10 prescription drug coupons with the biggest savings

Take steps to communicate clearly

To help you communicate with your healthcare provider, the National Institutes of Health recommends you:

  • Write down a list of questions/concerns before your appointment
  • Bring a close friend, caretaker, or family member with you to your appointment
  • Take notes (or have a your companion take notes) during your appointment about what the doctor says
  • Learn how to access your medical records, so you can keep track of important information
  • Take time to understand your insurance coverage to avoid unexpected copayments on doctor’s visits and prescription refills
  • Ask for the doctor’s contact information and their preferred method of communication in case you have follow-up questions
  • Remember that nurses and pharmacists are also good sources for patient education 

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Incorporate medication in your routine

It’s also a good idea to make your treatment regimen a regular part of your routine. That means linking a medication dose to something you do daily, like brushing your teeth. If it’s still hard to remember, use a mobile phone app or alarm to alert you when it’s time to take your medication. 

Medication adherence is a complicated problem, but taking some simple steps can help to improve poor adherence and patient outcomes.

Benefits of taking medications as prescribed

Taking your medications as prescribed is for the benefit of your health and well-being. Long-term control of your blood pressure (hypertension), blood glucose (diabetes), and other important parameters have been proven to lead to longer, healthier lives. If you have risk factors for heart disease, kidney disease, or other serious conditions, being compliant with early treatment and intervention is key to your success in controlling these conditions and their impact on your life. Work with your doctor and pharmacist to find the best regimen that you can stick with and be successful. When you do, your health wins!