Ralph Moss Limited

-Take Drugs Properly

To Ensure They Work

MANY OF TODAY'S MEDICATIONS are "miracle" drugs that help to control and cure illnesses and diseases that in the past were often untreated or treated inadequately. Modern drugs help cut hospital stays, reduce the need for surgery, and speed recovery. More importantly, they can prolong life and help those who suffer from illnesses or diseases live. healthier and more productive lives

But these benefits can only be realized if medications are used properly and when patients comply with instructions for use of prescribed treatments.

50 Per Cent are Noncomplient A recent study of inappropriate drug use and noncompliance in Canada found that only 50 per cent of prescription drug users take their medications as directed. The rest are noncompliant, either deliberately or unintentionally. Approximately 33 per cent of prescription drug users either do not fill their prescriptions or buy the medications but fail to use them. Seventeen per cent do not follow their physicians' instructions regarding use of their medications.

Noncompliance does not seem to vary by gender, race, socioeconomic status or educational level. It is found in all age groups and across all types of diseases and illnesses.

Noncompliance Noncompliant patients misuse drugs in a number of ways: they take prescription medication that belongs to others, forget to take their medications, take the wrong

dose (too little or too much), give up medications because they experience unpleasant side effects, take medications erratically, stop taking a medication when they begin to feel better, or finish "old" prescriptions at a later date. Not taking prescribed medications as directed may cause a patient's condition to fail to improve.

It is generally felt that noncompliance arises from any or all of three common causes:

• . the patient's attitude towards illness and medications;
• the specific relationship the patient has with the physician;
• the nature of a specific disease - for example, a symptomless disorder like high blood pressure provides little discomfort or pain which would encourage patients to follow treatment. Patients may not be compliant with their drug therapy since their medication doesn't provide results they can feel which would help them recognize that the medication is working.

Insufficient Treatment

Noncompliance also directly affects how well a specific drug treatment program will work, and may prolong illnesses and keep patients from improving as they should. Stopping a medication too soon, before the time authorized by a physician, may make a treatment ineffective. For example, if the full course of therapy of an antibiotic prescribed to fight a bacterial infection is not finished, some bacteria may remain alive and cause the infection to flare up.

Another form of noncompliance is to take a "drug holiday" or time off from medication for a long-term illness or disease. Often the benefits of maintenance medications are not appreciated until a patient stops taking them. At that point, insufficient drug therapy may result in complications or an increase in the severity of the disease.

Who Is
Noncompliant?

Noncompliance is defined as not adhering to a physician's instructions when taking medications. It can include any of the following:

1. not having a prescription filled or refilled;
2. taking too much or too little of the medication;
3. erratic use, such as altering time intervals or omitting doses;
4. stopping the medication too soon.

Inappropriate use can include:

1. taking medications not prescribed by using friends' or relatives' unfinished prescription medications; :
2. combining prescription medications with over-the-counter medications or illicit drugs, leading to possible adverse reactions;
3. self-medication by using old, unfinished prescription medications prior to, or instead of, consultation with a physician;
4. combining prescription medications with alcohol.

Source: Review of the Scientific Literature on the Prevalence,
Consequences, and Health Costs of Noncompliance and Inappropriate
Use of Prescription Medication in Canada

Ensuring Compliance The study of inappropriate drug use and noncompliance previously mentioned, reported that patients forget up to 70 per cent of the information they have received from their physicians. In addition, patients may not be compliant with their prescription drug therapies for any of a number of reasons, including:

• not fully believing in the value of the treatment;
• not having the funds to purchase the prescribed medication;
• not fully understanding how to take their medications.

Noncompliance is directly proportional to the number of medications prescribed and used. Because of this, it is critical that the patient know what each drug is for and when it should be taken.

The Patient's Responsibility Drug therapy is prescribed by a physician and dispensed by a pharmacist. In reality, however, the responsibility for treatment remains with the patient. After all, it is the patient who decides to fill the prescription, take the medication as prescribed, and refill the prescription as instructed. Patients should:

• ensure they have received sufficient education and information about their medical conditions to allow them to positively contribute towards their own health;
• understand and appreciate their diseases and illnesses, as well as the consequences of their diseases and illnesses, because only then will they make the necessary lifestyle changes to follow recommended treatment and help their medical conditions; understand the importance of their treatment plans and the rationale behind their therapies, asking for written instructions if necessary;
• develop a plan detailing how and when to take their medications, including how to fit medication use into work and home life;
• discuss any concerns they may have with their medication therapy with their pharmacists and other health professionals. The effectiveness of medication may change together with other changes in life, so adjustments to medication therapy may be required to improve compliance.

Thousands of people die each year in Canada because of medication noncompliance. It is up to patients to comply with their physicians instructions and ensure that they are not victims of noncompliance.

This article is not intended to give medical advice or provide suggestions regarding specific treatment. A physician should be consulted in all cases where problems are suspected.

How to Improve Compliance

1. Follow physicians' orders and take all medications as directed.
2. Finish all medication, even if symptoms disappear.
3. Do not take anyone else's medications.
4. Use a pill organizer to help remember when to take medication.
5. Ask questions of health professionals to improve understanding of physicians instructions, including:

• What foods or beverages should I avoid while taking the medication?
• When should I take my medication - before, with, after or between meals?
• Will the medication affect any of the other prescription or nonprescription medications I am taking?
• What should I do if I miss a dose?

Working With Health Professionals

Health professionals - physicians, nurses, pharmacists - can provide patients with information they may need to improve their incentive and motivation to take their medications, while helping them comply with instructions for their use.

Pharmacists can work with patients to develop a Pharmacy Care Plan that can include the following information:

• how the medication will help and methods the patient can use to keep track of this - for example, check blood pressure regularly to monitor high blood pressure medication;
• how the medication will make the patient feel, including signs it is working and expected side effects;
• what the patient can do to improve the effectiveness of the medication;
• what the patient can do to minimize side effects;
• what the patient should do if he or she notices side effects, e.g., contact the pharmacist or physician for further instructions rather than discontinue the medication;
• how to fit medication use into the patient's lifestyle - this may include helpful hints (such as memory aids, dosage calendars or pill organizers), or may require a modification of dosing instructions, or even a change in medication to one that has a dosage schedule that makes it easier to follow.

The information and opinions contained in this newsletter are obtained from various sources and believed to be reliable, but their accuracy cannot be guaranteed. Readers are urged to consult their professional advisors before acting on the basis of material contained in the newsletter.

Last updated October 1, 1997
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Copyright© 1996 All rights Reserved, Ralph Moss Limited
This article has been reproduced from Employee Benefits News by Manulife Fiancial Group Benefits