Taking a prescription medication can be essential to regaining or maintaining health, but all too often patients do not properly follow the instructions for taking these drugs. In fact, nationwide, about half of prescription drugs are not taken as prescribed.
The reasons, according to Carol M. Mangione, MD, MSPH, chief of the UCLA Division of General Internal Medicine and Health Services Research, range from difficulty affording out-of-pocket costs and obtaining timely refills to concerns about possible side effects and the complexity of medication regimens.
This is particularly true for individuals with multiple prescriptions, including pills that need to be taken at various times of the day.
Whatever the reason, the consequences of not adhering to important prescriptions can be significant. Dr. Mangione notes that, for example, underusing a medication for chronic pain can significantly affect quality of life, while taking too much of that drug can affect a person’s cognition or balance, increasing the risk of falls in older patients. Misuse of common medications, including insulin for diabetes and warfarin to prevent blood clots, is responsible for the majority of the nearly 200,000 emergency hospitalizations for adverse drug events each year among older adults. And even when the impact is less obvious, there is a significant downside to improperly taking drugs intended to reduce risk or treat conditions. “Patients who aren’t getting the full benefit from medications for their blood pressure, glucose and cholesterol are more vulnerable to heart disease, stroke and complications from diabetes,” Dr. Mangione notes.
UCLA Health instituted the “Managing Your Medication for Education and Daily Support,” or MyMeds, program to improve prescription adherence through a collaboration among UCLA clinical pharmacists and primary care physicians. MyMeds pharmacists consult with patients on their medication management, helping them to overcome any barriers that stand in their way. A MyMeds pharmacy consultation may be requested by a patient with a UCLA Health primary care physician.
Some patients struggle with high out-of-pocket costs for their prescription drugs. “It is not unusual for a patient to show up at the pharmacy, realize the medicine is expensive or not covered and not pick it up, or buy it but take less than what was prescribed so that it will last longer,” says Janet S. Chon, PharmD, a MyMeds clinical pharmacist. In such cases, Dr. Chon and her colleagues work with physicians to identify lower-cost therapeutic equivalents or patient assistance programs.
Other patients have difficulty adhering to regimens that involve multiple pills that must be taken at different times throughout the day. MyMeds clinical pharmacists help simplify patients’ complex medication regimens by streamlining them (i.e., switching them to long-acting formulations). They may also provide pillboxes and create medication schedules to make the process easier to manage.
Dr. Chon advises that patients keep an updated list of the medications they’re taking — even bringing all medicine bottles with them each time they visit their pharmacist — to make sure that what’s in their electronic chart is accurate. Patients should inform their physician or pharmacist of any over-the-counter drugs or supplements they use, since in some cases these may interact with prescription medicines in ways that may result in side effects or render them less effective. When being prescribed a medication, patients should ask about its purpose and common side effects.
It is particularly important for older patients to ensure that their medication regimen is optimal and that there are no problems with adherence, notes Albert Bui, MD, a UCLA geriatric specialist. Dr. Bui says an all-too-common phenomenon for older patients is what’s known as a prescription cascade, in which a medication causes a side effect that is then treated by another medication, which leads to a new side effect and another prescription, and so on.
“I tell my geriatric patients that if they have a new symptom, before asking what medication they can take for it, they should see if there’s a medication they can stop taking, because that symptom could be a side effect of another drug that they no longer need,” Dr. Bui says.