Taking medications as prescribed is critical to improving health outcomes – especially for patients living with chronic diseases – yet many Canadians are unable to do so for a variety of reasons. On average, 20-30 percent of prescriptions in Canada are never filled. When prescriptions are filled, nearly 26 percent of Canadians admit to taking medications differently than prescribed, while 21 percent say they’ve stopped taking medications before advised, or without consulting their doctor.
This can have serious consequences, both clinically and economically. Medication non-adherence results in billions of avoidable costs for healthcare systems around the world, due to repeated hospital admissions and increased physician visits.
“Medications are prescribed in a particular way to optimize health outcomes,” said Dr. Naila Kassam, primary care physician and Think Research’s Senior Medical Advisor. “Whether it’s a certain dose to be taken at certain times, or at a specified frequency, it’s all very important. Unfortunately, failure to take medications as prescribed can cause diseases and health conditions to worsen, so it’s important to think about patient considerations such as cost and dosing frequency when starting a new medication.”
Why Patients Don’t Adhere
There are many reasons patients are unable to comply with prescriptions. Some of the most frequently cited include:
Canadians deal with some of the highest medication costs in the world, and while many individuals have private coverage through their employers, some provincial and territorial public plans include very high co-pays and deductibles. As a result, 1 in 10 Canadians will not adhere to a prescription due to cost-related issues, with many identifying high monthly medication costs, lack of coverage, and high out-of-pocket costs as the major barrier.
Literacy and understanding
Health literacy is defined as a patient’s ability to access, process, and understand health-related information to make good health decisions. An estimated 60 percent of Canadians lack sufficient health literacy skills, which can lead to decreased medication adherence.
Age and level of education are regularly associated with lower health literacy, with the issue being most problematic among patients older than 60, who are also most likely to be impacted by chronic diseases.
Additionally, most healthcare material and instructions are written in a way that is often overly complex. Medical literature, including pamphlets, information on illnesses, consent forms, care plans, medication bottles, etc., are typically written at a grade 10 level, yet 48 percent of Canadian adults have literacy skills that fall below a high school level.
As symptoms start resolving, it’s not uncommon for patients to think their health condition has been corrected, and it’s ok to stop taking medications. However, stopping medications abruptly or even lessening doses can cause conditions to worsen and/or lead to unpleasant side effects. Patients should always take medications as directed and talk to their healthcare provider before changing doses or stopping altogether.
“If symptoms start to subside, that’s an indication the medication is doing its job,” said Dr. Kassam. “Even if patients are feeling better, they should always finish prescriptions or check with their doctor before making any changes.”
Undesirable side effects
A number of medications create unpleasant side effects that patients wish to avoid. This can include a vast range of conditions, from dry mouth and weight gain, to nausea, diarrhea, and drowsiness. Some side effects will go away as patients adapt to the new medication, however if side effects are lingering or causing too much discomfort, patients should speak with their doctor.
Forgetfulness is one of the most commonly reported causes of unintentional non-adherence, with nearly 23 percent of Canadians admitting they have a problem remembering to take medications on a regular basis, especially when their care plan is complicated.
What Can Clinicians do?
Though some non-adherence causes are harder to overcome than others, there are a number of things clinicians can do to improve medication adherence rates.
Communication is key to improving medication adherence. It’s critical that clinicians take the time to explain a patient’s condition, the benefits of the medication, and the consequences of non-adherence in a way the patient will understand. Do not rely on literature alone to convey critical information to patients or their caregivers.
Clinicians should also use open-ended questions when discussing adherence, as this approach has proven to elicit more informative responses. For example, instead of asking “Are you taking your medication?” ask “How do you think the medication is working for you?” or “What’s the hardest thing about taking your medications?”
Whenever possible, use the simplest level of prescribing. Also be sure patients are aware of any medication delivery services in their area.
Discuss medication aids
From calendars to phone apps and pill boxes, ensure patients are aware of the range of tools available to help organize and remind them to take medications.
Follow-up regularly with patients to discuss their condition and medication regimen. During visits, look for clues patients aren’t adhering to medication as directed. Some signs include regularly cancelling appointments, non-aligned pill counts, missed refills, escalating therapies without improvement in clinical measures, and the presence of depression or use of alternative medicines.
An estimated 83 percent of patients would never tell a provider they weren’t planning to fill a new prescription. Maintaining a supportive, blame-free environment where patients feel safe to openly discuss their condition and their prescription adherence, either by direct inquiry or questionnaires can improve adherence rates.
“Creating an environment where patients feel comfortable discussing treatment plans and potential barriers to adhering to medications is key to improving health outcomes,” said Dr. Kassam. “Picking up on signs of non-adherence can help correct the problem before conditions worsen.”
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