A Dose of Adherence

By Robert E. Mayfield, M.D.

The word “adherence” implies that the individual is taking an active role in the program they are practicing, while the word “compliance” implies that the individual is more or less following directions. This is why it is more important to address concerns of medications and the taking of them more appropriately as adherence.

Up to 50 percent of patients do not take their medications as prescribed.³ Although factors involved for this lack of adherence are myriad, there are three that are basic and relate to:

• The patient, who often lacks the involvement and health literacy demanded in administering their medications.
• The physician, who is often ineffective in communication regarding reasons for prescribing a medication, complications as a result of NOT taking a medication and the particular side effects of medications with possible ways to mitigate them.
• The program of health care that suffers from problems of limited time for patient appointments and difficulties with access to care.

These problems are not new to medicine in any way. Going back 2,000 years, the Hippocratic Oath states to the physician to “not only be prepared to do what is right himself, but also to make the patient…cooperate.” More recently, our former Surgeon General Dr. C. Everett Koop stated, “Drugs don’t work in patients who don’t take them.”

In efforts to enhance successful adherence, you should know your medications and why you are taking each individual prescription. In practice, many patients are notorious for stating, “I take a pink square one and a round white one.” Another frequent response is, “You should have them in my record.” Know your medications. If your doctor does not, insist that you review them at every visit. Keep a list of your medications with you at all times. While reviewing medications at every visit may seem redundant, there are many factors that make this necessary.  For instance, a doctor may forget to remove a discontinued medication from your list. Insurances change their formularies (menus of drugs covered by the plan) like people change underwear. As a result, different medications are often substituted into a patient’s regimen. Finally, most patients do not just see one doctor, especially those with a chronic or rare disease. Therefore, other physicians may be changing medications. Everyone must be on the same page and ultimately, the patient is as equally responsible as the physician for maintaining a correct list.

Once you know your medications, it will be easier for you to take them. However, you must also remember to take them. Incorporating a pillbox into your routine is most often the best way to achieve this critical goal. A pillbox provides you with a concrete visual cue as to whether you have taken your medications. Also, it allows you to keep your pill bottles in one secure and dedicated location. If you misplace your pillbox, at least you know where your main supply is. If you misplace a pill bottle, this can result in the loss of a month or even up to 90 days of a medication. This can be a very costly problem as not many patients are going to pay out-of-pocket for a misplaced prescription. An insurer or pharmacy will not pay for such a loss. Other methods to enhance your ability to remember to take your medication can involve a checklist on your calendar, setting alarms, or even using a service that can send you text messages as reminders.

Problems with side effects will also result in a failure to adhere. Rely on your physician for information on the most common side effects when you are beginning a drug that is new to you. In practice, a physician will know the most common side effects from feedback from his or her patients. While the pharmacy will provide you with a detailed list of side effects that is thoroughly researched, please bear in mind that these side effect profiles come from comparison to placebo (an inactive substance) and because our bodies do interesting things, not everything we experience is a true drug side effect. Make sure you get the answers that you need from your physician.

Getting those answers takes time for which the system often does not allow. When scheduling an appointment you can always try to ask for an extended visit or explain that you have multiple issues to discuss. Another way to help you in your education and adherence is to set up more frequent visits based on your needs and not the direction of the physician. Remember that adherence is a group effort. It is not solely your responsibility nor is it the sole responsibility of the physician. Adherence mandates a team approach.

Cost can prove a huge barrier to medication adherence. Some patients may take a medication every other day in order to “stretch things out.” Some will only take a medication when they feel bad. However, many disease states are silent in the early stages and feeling bad is a sign of progression of a disease and potentially permanent end-organ damage. Such nonadherence may make more medications necessary, and a greater expense.

To help meet the needs and requirements of successful adherence, Caring Voice Coalition is here. It is our mission to provide financial, educational and emotional support to our patients. Through financial support there is the elimination of the issue of cost. Educational and emotional support can assist in getting around the barriers discussed in taking your medications.

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