Researchers Find It Tough Getting Senior Citizens
and Others to Take Their Medicine
The most effective strategies did not lead to major
improvements in adherence or health
May 1, 2008 - Much has been written about the
problem of senior citizens failing to take their prescribed medicines. A
new study, however, shows it is not just a problem among older people
and it appears almost hopeless. Patients of all ages often do not take
the medicines their doctors prescribe, and this new review of existing
research suggests that there is no proven way to get them to follow
directions for long periods.
“Simple things don’t work and nothing works very
well,” said review lead author Dr. R. Brian Haynes of the McMaster
University Faculty of Health Sciences in Hamilton, Ontario.
Still, doctors can achieve limited success by
trying a number of approaches such as sending reminders to patients and
following up with phone calls.
Medicine, of course, does not work if patients do
not take it and studies have shown that “patient adherence” - taking
drugs as prescribed - is far from guaranteed, even in those with
life-threatening conditions.
One 1979 study estimated that patients only take
half of the doses of the prescription medications they administer
themselves. Few people take all of their medications and many do not
bother to take any, Haynes said.
Not surprisingly, a failure to take prescribed
medications is associated with higher death rates. “With growing numbers
of treatments that work when taken, the gap between the potential
benefits of current treatments and the actual benefits continues to
grow,” Haynes said.
There are many potential reasons why patients might
not bother to take their medications; they can include mental illnesses,
such as depression, or the complexity of drug regimens for conditions
like diabetes, Haynes said.
The review appears in the latest issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
topic.
For the review, which updates a 2005 review, Haynes
and colleagues included studies that were randomized, controlled trials,
meaning that researchers randomly assigned patients to different groups
then compared the results.
The studies had to look at both adherence and
outcome - what happened to the patients medically.
While hundreds of studies have looked at patient
adherence, the review authors only found 78 that met their criteria.
They included patients with a variety of diseases, such as high-blood
pressure, heart failure and HIV.
Some studies looked at short-term adherence to drug
regimens - between one and three weeks.
In nine of these studies, four of 10 strategies
seemed to improve proper drug taking and improve patients’ health in at
least one way. (For example, one strategy helped the patients take their
drugs properly, but did not make them get better.)
These findings suggest that simple approaches can
be effective, Haynes said. Among others, approaches that are more
successful include counseling and providing written instructions and
pill packaging that helps patients take their drugs properly - like the
day-by-day dose packaging for birth-control pills.
Getting patients to take their drugs over long
periods is much more challenging. Just 25 of 81 strategies - reported in
a total of 69 studies - actually helped patients get better. Thirty-six
strategies led to improved adherence.
The review authors found that almost all of the
more successful long-term strategies were complex “combinations of more
convenient care, information, reminders, self-monitoring, reinforcement,
counseling, family therapy, psychological therapy, crisis intervention,
manual telephone follow-up and supportive care.”
Even the most effective strategies did not lead to
major improvements in adherence or the health of patients.
Debra Roter, a professor at Johns Hopkins Bloomberg
School of Public Health, said the review has limitations. The studies
examined are indeed rigorous, she said, but “in real life, you don’t
have such rigorously controlled circumstances.”
According to Roter, a commitment to the most
rigorous research methods often produces strategies that are simplistic
and inflexible. “You need community-based observational studies that
have all the messiness of what patients do in everyday life.”
What to do? Study lead author Haynes says doctors
need to emphasize the importance of taking drugs properly and try to
spend more time with patients who fail to do so.
“Teamwork can help: nurses, pharmacists, sometimes
a family member or friend,” he said.
As for patients, they need to be honest with their
doctors about whether they skip doses of medicine, Haynes said. “Your
doctor can’t tell if you are not taking your meds and may over-prescribe
if she thinks it isn’t working when, in fact, you aren’t taking it.”
Original report written by Randy Dotinga,
Contributing Writer, Health Behavior News Service
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