The basic tenet of non compliance is the failure to take medication according to prescribed directions. But it’s more than non adherence to directions, non compliance is also indicative of the misuse of medication. Here are five common causes of non compliance and how healthcare professionals can help.
- Side Effects. In a “perfect drug” scenario, medications would zero in on their intended target systems generating only desired, therapeutic effects, then metabolize and leave the body. Unfortunately, it’s not that simple, as medications produce unintended consequences as well.
How healthcare professionals can help: It is important to be honest with clients about side effects. Point out that although practically every drug – prescription and over-the-counter – has side effects, many of them are short-lived and “run their course,” so to speak, after the body adapts to the new substance. Discuss the typical side effects of the medications that the client is taking, and suggest ways for combating them. For example, drugs that are associated with the side effects of anxiety and insomnia are best taken in the morning. Sedating medications should be taken at bedtime and those linked to nausea are to be consumed on a full stomach.
- Cost. Unfortunately, most brand name medications are outrageously expensive nowadays. So it is no surprise that the poor and particularly the elderly on fixed incomes are prone to breaking their medications in half or taking them every other day. As important as medication may be to quality of life and even survival, it’s not high in the pecking order when it comes to one’s hierarchy of needs.
How healthcare professionals can help: The place to start is with the client’s choice of insurance company or plan. Help them find out about the range of prescription benefits and whether or not the medications they’re taking are covered under their plan. Clarify co-pay information and whether or not brand drugs are covered. This is particularly important if they’re taking several medications. Medicare beneficiaries can switch their prescription-drug coverage between November 15 and December 31.
Suggest comparison-shopping among several pharmacies. There are often disparaging price differences for the same drug from pharmacy to pharmacy. There are also a number of useful Web sites that can assist clients with comparison-shopping. The site www.destinationRx.comwww.Rxvouchers.com for coupons that can be used for medications.
A number of assistance programs are available through states, nonprofits and drug companies. Contact the Partnership for Prescription Assistance at 888.477.2669 or www.pparx.org for eligibility requirements. PPA helps the uninsured or those struggling financially to gain access to about 475 assistance programs that are either free or very low cost.
Find out if the client’s physician is willing to prescribe either a less expensive brand of the medication they’re taking or a generic. More and more pharmacies are following Wal-Mart’s lead and are offering some generics for as little as $4.00 per prescription.
The purchase of prescriptions via mail order, particularly in larger quantities, offers handsome savings in many instances.
- Forgetfulness. Forgetting to take medication according to prescribed directions is the most common cause of non compliance. It is often the result of poor organization, memory compromise and sometimes downright obstinance, that is, some people “conveniently” forget.
How healthcare professionals can help: Compartmentalized pillboxes, medication calendars, post-it note reminders, timers and even high tech talking devices that sound an alarm when a dose is missed are all helpful. Help clients set up a strategy for taking medications at the same time every day and enlist the help of family members whenever possible. Available and supportive family members can either administer medication directly to the client or remind them via a phone call. The key here is to set up a clockwork pattern of daily repetition for the consumption of medication.
- The I’m Cured Syndrome. Way too many people treat prescribed medication as they would a Tylenol for a simple, uncomplicated tension headache. That is, once they either begin to feel better or their symptoms remit, they abruptly stop or gradually discontinue the drug. The reasoning for this action, albeit illogical, is simple. Most people want to be done with medication as quickly as possible because it is viewed as a necessary evil. For many, having to take medication serves as an ever-present reminder of something undesirable, such as a physical illness or mental disorder.
How healthcare professionals can help: This one can be tough and is at times met with resistance. But clients need to be reminded that medication is a vehicle that has fostered improvement in the first place, and that abrupt or gradual discontinuation isn’t warranted without the approval or recommendation from the client’s prescriber. Some clients need to bluntly hear that this is a matter they shouldn’t take into their own hands.
- Frequency of Use. This is a rather linear issue. The more times per day someone has to take a medication, the greater the frequency of a missed dose. It’s that simple. There’s also a” multiplier effect” associated with frequency of use that is exacerbated in the client taking multiple medications. This can make for a real mess.
How healthcare professionals can help: Research whether the client’s medication is possibly available in a once-daily formulation. If so, teach them how they can advocate with their physician on their own behalf for once-daily preparations. If not available, the aforementioned clockwork pattern of medication use that fosters a cycle of daily repetition becomes even more important.