Archive for January, 2005

Medication Noncompliance: A Prescription for Disaster

January 18th, 2005 by Melanie Matthews

Guest Blogger: Jennifer Millman

A HIN colleague recently told me a disturbing story:

My friend's 25-year-old son was prescribed Xanax for short-term relief of mild to moderate anxiety. He had one drink at a party last summer and the chemical interaction knocked him out. He died without ever regaining consciousness. Doctors attributed his death to an adverse drug reaction – a side effect explicitly warned about in prescription instructions.

This anecdote stung me, but almost more horrifying than its particular details was its striking familiarity. I'd heard it before – stories of other people, other chemical interactions and other scenarios. Although not always deadly, such incidents are, unfortunately, all too common.

So why don't we just start heeding the labels? It's not that simple; prescription noncompliance occurs for multiple reasons. Maybe it's poor physician communication. It may be language barriers, inadequate aftercare plans, insufficient patient education and small prescription labels, cultural norms and practices, lack of social support, feelings of invincibility, futility or any combination of these causes, among others.

My colleague's anecdote was particularly timely for me because I had stumbled across a journal article on medication nonadherence while surfing the Internet earlier that morning. In his report, Harold Gottlieb, PhD illuminated the daunting pervasiveness of noncompliance:

  • Estimates from 30 to 60 percent, highest when symptom-free;
  • For long-term prescriptions, compliance rates dropped to 50 percent for either cure or prevention;
  • Twenty to 80 percent of patients make errors in taking medication;
  • Twenty to 60 percent stop taking medications before instructed;
  • In older populations, compliance rates average less than 45 percent;
  • Forty to 60 percent of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information; and
  • More than 60 percent of patients misunderstood prescription directions immediately after doctor visits.

This is a problem. And I don't think there's an isolated explanation.

But I do think we've got to increase awareness – focus groups, detailed diagnostic summaries, explicit treatment plans, adherence contracts and enhanced communication. We've got to address both physicians and patients – gear educational materials toward motivating resistant patients, improving pharmacy management and assuming more personal responsibility for our healthcare decisions. Capitalizing on top-of-the-line research and technology, pharmacy has explosive potential to manage and improve conditions. But if physicians don't clarify their instructions and patients don't heed doctor's orders, what are they doing? And if all this stems from a rapidly evolving healthcare industry with too little time, too much spending and too many patients, what can we do to change it?

I don't have a sure answer and persistent, unchecked noncompliance suggests a systemic perplexity more profound than my own. The ambiguity disturbs me. For a moment, I put myself as the lead character in my colleague's story. Would I have had one drink one night? I can't say, unequivocally, the answer would be no.