Patients not taking their Medications as Directed: A “Gorilla” of a Problem!

By Julie Fulmer-Mason

When a doctor takes the effort to simply prescribe a medication for a patient, there are a number of steps that need to be taken in order for the patient to take the “right dose” of that medication at the “right time”. These steps involve the patient going to the pharmacy to get the prescription filled, having the adequate finances or insurance coverage to afford the medication, understanding the directions of how to take the medication, and having an adequate reminder system in place in order to prevent any missed doses. The journey from the written prescription to the medication actually being consumed or used by the patient as directed is what the health care field calls “Medication Adherence”.

Unfortunately, poor medication adherence is a national problem that our health care system faces today. Of the 1.8 billion prescription medications dispensed annually in the United States, 51% are not taken correctly. This staggering statistic accounts for 125,000 medication-related deaths per year, 10% of all hospital admissions, and 23% of new admissions to care facilities (i.e. assisted living, independent care, nursing home, and skilled nursing). Taking into account the resources utilized during these medication-related ER visits and hospital/care facility stays, it costs Americans $290 billion per year for this very preventable, unavoidable problem! The health care industry has known for some time that improved medication adherence can lead to better health outcomes and reductions in health care spending. Unfortunately, the issue of medication non-adherence became the “big gorilla” in the room that nobody quite knew how to address. If insurers, government payers, health care facilities, and patients do not start to actively address this issue, the worry is that this “big gorilla” is going to turn into “King Kong” with the rising tides of the Silver Tsunami!

What can patients do? Quite simply, patients need to become advocates for their own health care and maintain complete control over their medication regimens. The two biggest problems patients face with their medications is forgetting to take them on time and not effectively communicating what medications they are taking to EVERY health care provider they visit. Some ideas to help patients improve their own medication adherence are:

• Get organized with a pillbox…If you take a multitude of prescriptions, the sheer sight of those similar looking amber or white-colored pharmacy bottles crowding your kitchen counter or medicine cabinet may be depressing. Also, the act of twisting and untwisting those child-proof prescription bottle caps multiple times per day may be a source of frustration. By organizing your medications in a portable pillbox, you can become liberated from your pill bottles every day, your medications can now move with you through your daily activities in life, and you know when you have missed a dose if your morning medications are still in the pillbox that night!

• Have a reminder system in place to prevent missed doses…The best way to remember to take your medications at the right time is to coordinate your medication doses with routine activities that you do at the same time every day, such as brushing your teeth, meal times, reading the newspaper, or brewing coffee. However, if you take medications multiple times per day or your lifestyle is far from routine, then a medication device that provides visual, audio, or electronic messaging reminder alerts may be a more beneficial option.

• Meet with your doctors and simplify your medication regimens…Every time you see a health care provider, YOU need to provide a written list of every prescription medication, over-the-counter medication, and vitamin that you are taking, including doses and directions. A good rule of thumb is to assume that your providers have no medication records for you and you need to provide the evidence! At every visit, engage your providers to review your medication list and see if they have any ideas in order to simplify your medications. Are there any of your medications that can be substituted with one of the new combination products? Are there any of your medications that come as a long-acting formulation, such that you can take it once-a-day instead of three-times-a-day? Is it still necessary to continue some of the medications that you are taking?

• Meet with your pharmacist and simplify your refills…Many missed doses occur when patients forget to refill their prescriptions on time. Your pharmacist is a great resource to work with in order to schedule the same refill dates for all your medications so that none of them are forgotten. If your pharmacy offers an automatic refill option, sign up so that you do not have to make that phone call every month. Also, if your insurance allows 90-day medication supplies, take advantage of only ordering your medications 4 times per year rather than 12 times per year!

• Keep it Simple…Patients tend to worry that some medications should not be combined with others, and as a result will tend to take their medications at 6 or 7 different times during the day. Unless a medication label specifically states that it needs to be taken 5 or more times per day, you should organize your medications in such a way that you only consume them at 4 daily dosing times (morning, noon, evening, and bedtime). Working with a pharmacist can give you a good idea of which medications can be taken together. Your medication adherence will improve dramatically by reducing the number of times you take your medications during the day!

About the Author:

Julie Fulmer-Mason is a pharmacist and the President of MedFolio, LLC. Julie received her Doctorate in Pharmacy from the University of California, San Francisco School of Pharmacy in 1998. Over the past decade, Julie has worked in the pharmaceutical industry and as a Clinical Ambulatory Care Pharmacist at the Veteran Affairs Health Care System in Palo Alto, California. Julie’s interactions with patients, caregivers, and health care providers motivated a passion of truly understanding the difficulties patients face with taking a multitude of medications. Instead of merely seeing patients to refill their pill boxes week after week, Julie empowered patients to become advocates for their own health care by finding methods in which they could fully understand, communicate, and live with their medication regimens. Based on these experiences, Julie started her own company, MedFolio LLC in 2008 not only as a means to advocate for the importance of medication adherence, but also to design products that truly help patients with independent 21st Century lifestyles to take control of their medications. Their first product, The MedFolio Electronic Pillbox, was released in 2011 and is targeted for the tech-savvy aging Baby Boomer generation…and their parents!