Have you ever gone to a doctor for a medical problem, had that physician prescribe a medication, but then ignored the doctor’s instructions and didn’t get that prescription filled?
If your answer is “yes” to that question, then your action is a common one. Studies show that nearly one-third of the medications prescribed to individuals remain unfilled.
In a recent Canadian study, researchers examined the prescription data of nearly 16,000 patients in a primary care network of over 130 doctors. Of the 37,000+ prescriptions written, almost one-third remained unfilled nine months later. The nine-month period was used to give patients time to fill those prescriptions in case some medications were prescribed on a “take as needed” basis.
As one might expect, the drugs most often not filled included the more expensive brand name drugs, but the non-compliance issue also included less expensive medications that are used to treat chronic conditions such as headache, heart disease and depression.
And the non-compliance issue was not limited to low-income patients. In fact, all of the patients in the Canadian study had some form of universal prescription insurance coverage, and this made the significance of medication non-compliance all the more surprising.
The prescriptions most often filled and taken as ordered included those for acute bronchitis and urinary tract infections, conditions that usually involve significant discomfort if not resolved quickly. For individuals with medical issues that exhibit with less obvious symptoms and no pain (such as high blood pressure, mild diabetes, and high cholesterol), the non-compliance rates were higher.
The study was designed to investigate adherence to medication prescribing only and did not specifically address patient attitudes or beliefs about medication prescribing, and it did not consider the consequences of medication non-compliance.
As a comparison to this study of Canadian patients with universal health care, prescription fill rates in the United States are slightly higher (between 72% and 78% depending on the study reviewed). But, although fill rates are surprisingly better in the US, non-compliance to specific medication dosing is also greater.
Dr. Troyen Brennen, executive vice president and chief medical officer of CVS Caremark stated, “If we can get people to take their medications, they’ll have fewer heart attacks, they won’t develop complications associated with diabetes and they won’t be going to the emergency department with asthma.”
Studies of US patients indicate that of the 32 million Americans that use three or more medications daily, 75% are non-adherent in one way or another. They simply do not take their medication properly for optimum effect.
This degree of non-compliant behavior (that includes not initially filling a prescribed medication as well as not taking a prescribed medication properly) has been estimated to create an economic impact of an additional $100 billon in yearly US health care costs and causes an estimated 125,000 needless deaths each year.
The various reasons for medication non-compliance are numerous. They include fear of medications, side effects experienced while on a therapy, and patient ignorance to the importance of a prescribed medication.
Nearly half of patients elect to discontinue an effective medication by either stopping the therapy early or taking their medications incorrectly. Many patients simply forget to take their medications, particularly with the elderly.
Compliance rates also varied with the type of physician who prescribed the therapy regimen. Prescriptions were filled more often when prescribed by primary care physicians, especially pediatricians. Interestingly, if the physician was a specialist, younger, female or part of a group of more than 10 physicians in a practice, then the patient’s prescription fill rate decreased.
It would seem that patient education regarding their illnesses, specifically the ones without noticeable symptoms, would encourage better medication compliance. When patients understand the seriousness of the so-called silent killers (high blood pressure, mild diabetes, high cholesterol) and the importance of proper dosing to eliminate side effects but maintain therapeutic results, then medication compliance most likely will improve.
When the health care model includes better communication between patients and their physicians and pharmacists, as well as better follow-up care from the prescribing physicians, then medication compliance issues will decrease and patient outcomes will increase.
Thoughts? Comments? I’d like to hear them!
Oh, oh! This one’s close to home, James. Caught in the non-act! Lurking in the desk drawer right beside me is an unfilled prescription. BTW, Canada’s (sort-of) ‘universal’ health care system does not cover the cost of prescriptions written by physicians, although all medications administered to patients in hospitals are covered. This varies somewhat among provinces. Good story, James. Thanks.
Ah ha – Caught you!! 🙂 Thanks for the clarification about Canadian prescribing rules. All the best!
Hi Jim. Do you have similar data for countries with universal healthcare systems, such as the UK or Sweden? It would be interesting to know how these compare. Charles
Unfortunately, I don’t have that information at this time. If one of my readers has such information, please enlighten us. Thanks, Charles, for your comments.
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