“The biggest challenge in health care today isn’t lack of new drugs or their cost — it’s simply getting patients to adhere to taking their current medications,” says
Adah Almutairi, PhD, associate professor in the
Skaggs School of Pharmacy and Pharmaceutical Sciences and director of the Center for Excellence in Nanomedicine at UC San Diego.
People usually don’t remember or want to take a pill every day and that’s a big hurdle to researchers like Almutairi, who are developing new therapeutics for a variety of diseases. “We can have the most brilliant idea, but if a patient won’t or can’t do it, we have to go back to the drawing board,” she says.
How big is the problem? According to the American Medical Association (AMA), approximately one-quarter of new prescriptions are never filled, and patients take their medications as prescribed roughly 50 percent of the time.
That adds up to more than $300 billion in preventable hospital costs related to failure to take medications as directed, says
Jonathan Watanabe, PharmD, PhD, assistant professor of clinical pharmacy in the Skaggs School of Pharmacy.
Lack of medication adherence is a burden, says Watanabe, who studies factors that keep patients prescribed cholesterol-lowering statins from taking them, because “doctors and pharmacists often assume patients are taking their medications, so when it appears the meds aren’t working, they increase the dose or switch to a new drug. We never really know how well the original drug and dose could have worked if taken properly.”
Just plain forgetting
Often times a person isn’t intentionally forgoing medication – we all forget sometimes. How can you make sure you take your medication on time, every time? Watanabe has a few simple tricks:
- Make it a habit – always do something else at the same time you take your medication, eating dinner, for example.
- Set a recurring alarm or calendar alert on your cell phone.
- Organize your pills in labeled pill boxes or opt for medications in blister packs — once the pills are laid out, you always know what you’ve already taken or need to take.
- If it can be done safely, keep your medications out in a place where you can’t miss them — on top of your laptop, for example, where you are forced to pick up the bottle in order to open it.
Even if taking your medication on time, every time isn’t always realistic, every bit counts. “There’s a big difference between 80 and 90 percent adherence,” Watanabe says. “Moving the needle up just a little bit can translate into big clinical improvements.”
In a recent report, the AMA outlined eight reasons patients intentionally fail to fill their prescriptions or take their medications. These include fear of potential side effects, cost, misunderstanding (as in misunderstanding the need for medication, nature of side effects and time necessary to see results), too many medications, lack of symptoms, concerns about becoming dependent on medication, depression and mistrust of the doctor’s motivations behind the prescription.
“We find that simply getting to the pharmacy to get a prescription filled is huge barrier for a lot of patients,” Watanabe says. “We can greatly increase the likelihood a patient will take their medications if we can at least shorten the time interval between doctor’s visit and pharmacy visit. That’s why clinics that include an on-site pharmacy can be very effective. We also use free samples, vouchers and cheaper medication copayments to try to boost adherence to starting a new medication.”
Education is also a key factor in helping patients stick to their drug treatments plans, Watanabe says. “It’s not as simple as handing over a prescription. There needs to be a dialogue between patient and doctor or pharmacist. Patients should feel empowered to ask questions and take the time to truly understand what the medication is, what it will do and what they can expect in terms of side effects. This is especially important for the so-called ‘silent syndromes’ — conditions such as hypertension and high cholesterol, where the patient doesn’t experience symptoms and so it can be easy to forget why it’s important to take those types of medications.”
The future of pharmacy
According to Watanabe, studies have shown that physicians spend less than a minute talking about new medications in an average patient visit. Pharmacists like him are now increasingly filling that gap, acting as a new type of primary health care provider. In 2014, California became the fourth state to allow pharmacists to initiate and monitor a patient’s drug therapy, rather than simply fulfill a doctor’s prescription.
More pharmaceutical advances are on the horizon. Watanabe says that pharmacists are trying to make drug regimens less complicated and lessen the “pill burden” with combination pills. They are also trying to reduce redundancies, so patients can take fewer medications and save money. Technological advances may help, too — “smart” pill dispensers can monitor a patient’s adherence in real time, for example.
Watanabe sees a future where doctors and pharmacists treat adherence like its own syndrome — a condition that needs to be fully recognized and remedied, just like anything else.
Meanwhile, Almutairi hopes researchers will eventually be able to take the patient out of the equation entirely.
“I want to find ways to have patients see a doctor or pharmacist just once a year to get their drugs administered, then they can forget about it while an implanted device continues to releases the right doses and the right time,” she says. “Taking medications should be like paying bills — it used to be time intensive, but now we set up autopay and forget about it.”
Care at UC San Diego Health