Johns Hopkins Health Alerts Prescription Drugs Failing to Take Medications According to Directions

Cynthia Rand, Ph.D., Director of the Johns Hopkins Center for Adherence Research, offers advice to help you avoid the “nonadherence trap.”

Medical nonadherence -- failing to take medications according to directions -- is a major healthcare problem. Over the past decade, the pharmaceutical industry has come up with an incredible array of medications for a vast number of illnesses. But because of overwhelming nonadherence, the true value of these medications is not being fully realized. If you did not take your medication today—or you did not take your medication properly—you have a lot of company. Each day about 50 million Americans either forget to take a medication that their doctor has prescribed or purposely decide not to take it.

The majority of medications taken by people over age 50 are prescribed for chronic illnesses like high blood pressure, diabetes, depression, and heart disease. Although in many instances these medications do not cure the condition, they prevent disease progression and are meant to be taken for months -- sometimes even for years.

The major reason for nonadherence is that some patients mistakenly believe that they no longer need a medication to keep one of these conditions under control. People often fall into this trap if the condition they have is not making them uncomfortable -- in other words, there are no overt symptoms.

Patients may also stop taking a medication because of bothersome side effects or cost. And some patients take the wrong amount of medication -- or maybe they take the right amount at the wrong time -- because they do not understand the instructions they were given. Others have difficulty prying open the pill bottle and give up, even if the medication is for a serious illness. There is also a group of patients that resists the very notion of medication as unnatural or an admission of weakness. Some of these patients also question the benefits of medication in general. Such patients may take a prescription that the doctor hands to them, but they never get it filled.

The variations on these themes are endless. Physicians can help patients make huge gains in adherence by being very clear about what medication they prescribe and why, and by periodically reviewing this information with each patient. All doctors should make this a routine part of the care that they provide—and you should expect it. The following measures will help you and your primary care doctor be certain that you are taking your medications properly:

• Brown-bag review. Once a year, pack up all of your medications and bring them with you to your appointment. Review each medication with the doctor, going over the number of pills that must be taken daily for each drug, why it is being taken, what time it should be taken, whether it should be taken with or without food, and what to do if you forget to take a dose. Feel free to take notes at this or any other appointment you have with your doctor.
• Be candid. If a prescribed drug is too costly to take as directed, ask for a lessexpensive alternative. If you have difficulty swallowing certain pills, find it inconvenient to take medications more than once a day, or experience side effects, share that information with your physician. Adjustments—such as changing the dose or time of day a drug is taken or switching to a different drug—can often be made.
• Keep medical records current. If a specialist prescribes a new medication, be sure to let your primary care doctor know immediately—and vice versa. Also, let your doctor know if you are taking any over-the-counter supplements. These products may have side effects. They can also interact with medications, both prescription and nonprescription.
• Consult your pharmacist. If you have any question whatsoever about a medication, talk to your pharmacist. He or she can provide you with a package insert describing the medication (large-print formats are available) and can provide advice based on professional experience and training.
• Use containers you can open. If you have trouble with childproof caps, be sure to ask your pharmacist for an easy-to-open variety. If there are young children in your home, be sure to keep non-childproof bottles out of their reach.
• Use memory and organizational aids. Ask friends or family members to remind you when to take your medications, link taking your medications with other daily events, keep your pill bottles in plain sight, set your alarm clock or watch as a reminder, post notes where you’ll see them, use pill boxes to sort your medications by the day or the week. Experiment with different techniques and devices, select the approaches that work best for you, and use them consistently.

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Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer

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Posted in Prescription Drugs on December 20, 2006
Reviewed July 2009