I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on June 01, 2010, 09:43:13 AM
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Why prescription drugs are not taken by patients
June 1, 2010 at 9:27 am
How many patients actually take the prescription drugs that their doctors prescribe them?
Less than you think.
Pauline Chen, in a recent New York Times’ column, discusses the worrisome issue of medication noncompliance.
And the numbers are stark. According to the data, “as many as half of all patients did not follow their doctors’ advice when it came to medications,” and, “more than 20 percent of first-time patient prescriptions were never filled.”
There are costs, of course. Patients who fail to take medications to treat their high blood pressure or diabetes are more likely to suffer complications and have a lower mortality rate. And data from comparative effectiveness studies and efforts from evidence based care will be rendered useless if patients don’t take their prescribed drugs.
Dr. Chen looks at some of the reasons why this is happen. And it comes down to one major reason — accessibility.
Apparently, the process of taking a prescription, driving to a pharmacy and waiting for it to be filled or faxed in is a huge barrier.
One solution would be to have a pharmacy in the physician’s office where patients can pick up their medication on the way out. Large, integrated health systems, like Kaiser in California, do this, lowering their noncompliance rate to around 5%.
We need to do a better job getting patients to take their medications, especially for chronic health conditions. Cost is one factor, but the growing array of generic drugs is making this less of an issue.
Convenience is key to compliance, and that’s something we need to better focus on if we want patients to follow our instructions.
http://www.kevinmd.com/blog/2010/06/prescription-drugs-patients.html
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Yes, yes, yes, cost is a lot of it. I am very compliant in taking my meds. However, I do know some people who are not. We are very blessed to have a pharmacy very close to us, who is not only super efficient, he compounds prescriptions and also, are you sitting down, will deliver if needed. To a lot of people, just getting to the pharmacy is daunting, let alone finding a parking space and then standing in line, only to be told that the Dr. did not order a refill is enough to make them give up.
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I get all of my meds via a mail-order service because my HMO makes it more advantageous to do it this way (for long-term meds). I order refills online and don't ever have to go to the pharmacy unless my neph puts me on something new and I need to have it right away. But not everyone has internet access, so this isn't a complete solution. The cost is so high...I take generics for just about everything, but it is still expensive, and that's with decent insurance coverage.
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I looked up the original article from the NYT and all it seems to say is that 20% of people don't fill first-time prescriptions. http://www.nytimes.com/2010/05/20/health/20chen.html?ref=health
This is telling us nothing about nonadherence. I know I have not filled prescriptions before, for a variety of reasons, including I simply disagree with the doctor about whether I actually need it. I don't know how they are defining "first-time prescription" either. First time from that particular doctor, or first time in your life? Because often when I go to a new doctor I will already have that prescription sitting at home from some other doctor, and will just take it from my supply. Nonadherence is notoriously difficult to study, because you must define what you mean by that. Not filling a prescription is an extreme case, what about not taking meds once a month?
The Kaiser scenario I find misleading. They have a greater fill rate, but that does not mean the patients are actually taking the meds, just that they are paying for them. I have filled prescriptions and never taken the meds, or tried one and had a horrible reaction. (My GP will give samples when he has them so we don't waste dosh on a potential failure.)
I don't find going to the pharmacy that much of a hardship, but I have always lived in metro areas. All my meds are overnighted from Chicago right now, so that's stupidly easy. In LA, I lived right across the street from two pharmacies - inconvenience was never an excuse I could use.
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I use a mail order for my maintenance perscriptions, I must say it is hard for me to get mine because I'm blind and have hard times finding people to take me to pick them up.
Troy
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I would like to see a study that plots the percentage of compliance against the number of prescribed meds per patient.
I am now on some twenty different meds and dietary supplements for my ESRD and other health problems, of which over fifteen I have to take orally. Not all at once, but spaced throughout the day: Some before breakfast, the phosphorus binders with every meal, some in between meals, and a couple at bedtime.
With that many meds and that kind of schedule, it's real easy to forget to take one.
I use Microsoft Outlook to remind me--and those reminders go off all throughout my day.