As many as half of adults in the U.S. are not taking their prescribed medications for serious chronic conditions, such as high blood pressure, according to some recent surveys and studies.
Moreover, it’s not a matter of cost. Most patients that fall under the so-called “medication nonadherence” category are covered by private insurance or Medicare. Some of these adults concede that they simply forget to take their meds. But many of them don’t fully grasp the significance of taking medication for heart disease risk factors, including high blood pressure, high cholesterol and diabetes or prediabetes, researchers say. These conditions, if unattended, can result in heart attacks, stroke or death.
As many as 33 to 69 percent of all medication-related hospital admissions in the United States may be due to poor medication adherence, which amounts to a cost of $100 billion a year, according to a study published last year in the American Medical Association’s JAMA Internal Medicine [1].
The study found that even providing patients with financial incentives and social support, along with digital pill bottles that signal when a dose should be taken, was not enough to boost medication adherence among heart attack survivors.
A separate study published last month in JAMA Internal Medicine [2] found that a smartphone app could lead to some improvement in self-reported medication adherence among participants with poorly controlled hypertension. However, participants using the app had no change in systolic blood pressure compared to their counterparts that were not using the app, researchers found.
Overall, a fear of potential side effects and a desire to be less reliant on drugs are the two top reasons patients don’t take their medications, according to some studies. This applies when the cost of medications is not a factor. But most primary care physicians, cardiologists and other specialists will work with patients to obtain low-cost drugs if they are not covered by Medicare or private health plans.
There is also another factor: the psychological impact of having to depend on medications for the first time, says Manuel Torres, M.D. [3], a family medicine physician with Baptist Health Primary Care [4] at Kendall Breeze.
“Sometimes I’ve struggled with patients who are going from not being on any medications to ‘Now I have to take a medication?’ It’s almost like a sign of aging to them and it can really affect someone psychologically,” explains Dr. Torres. “But I don’t want that to be the case. I want them to understand that our longevity, and how we’ve been able to expand our life span, is because of the science behind medications. My intention is never to make their lives more difficult. My intention is to help you control these numbers.”
Researchers in the study that provided various incentives to more than 1,500 participants conceded they were not certain why so many heart attack survivors did not adhere to a full schedule of prescribed medications.
“Perhaps the multiple medications required or use of electronic pill bottles makes adherence daunting,” the authors of the study wrote. “Perhaps the goal of avoiding subsequent (heart attack) is maximally motivating, so that further efforts toward motivation are ineffective.”
Researchers also said that patient concerns about “potential adverse effects of these medications, such as impotence or fatigue, were not targeted by this engagement strategy.”
Dr. Torres says that another factor adds to the anxiety of side effects: Those ubiquitous TV commercials from drug companies that spend more time talking about risky side effects than the benefits of taking a certain medication. Having a thorough discussion with your doctor about a medication’s potential side effect is vitally important, he says.
“Just because a side effect is given on that long list of information that you get from your pharmacy, that doesn’t mean it’s going to happen to you,” says Dr. Torres. “Any side effect that is mentioned to investigators during an investigative trial has to be reported and has to be on the information reported to the patient. Of course, this education is great, but I always try to temper patients’ responses and help them understand that those side effects may happen but are not going to always happen.”