Reminders for patients to take their medications are not enough

The most common opinion of patients who don’t take their medications is they’re forgetful and need reminders. This may be true of some people, but many choose not to take their medication.

In a very illuminating study recently published in the Archives of Internal Medicine, “Effects of Benefits and Harms on Older Persons’ Willingness to Take Medication for Primary Cardiovascular Prevention”, the researchers conducted in-person interviews with 356 community-living older persons who were asked about their willingness to take medication for primary prevention of myocardial infarction (MI). Contrast these two key findings:

  • 88% were willing to take a medication that provided a 30% relative reduction in MI risk if there were no adverse events.
  • But, if the medication caused mild fatigue, fuzzy thinking and nausea, and only provided less benefit, 48% to 69% would not take it.

In other words, what this study shows is that, when taking their medications, people are weighing whether to take it or not.  Do the pros outweigh the cons? In the scale below, a glaucoma patient weighs the potential benefits of taking the prescribed medication against the benefits of not taking the medication (thanks to Dr Melissa Hunt at University of Pennsylvania for the idea behind this scale):

What this scale is depicts are the relatives weights that a glaucoma patient might judge the importance of taking or not taking medication.

True, for some, non-adherence may just mean they forgot. But, for many — and the high percentages and costs for non-adherence seem to indicate this — non-adherence is a rational, conscious, and deliberate decision. No reminder (e.g. text from health insurer, letter from pharmacy, etc) in the world will get them to take their medication.

As Dr Hunt explains, “Adherence is not simply blind compliance. Adherence is an active and voluntary choice by the patient.”

Boxcutters Gem #1154 – Reminders for patients to take their medications are not enough.

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10 Responses to “Reminders for patients to take their medications are not enough”
  1. You tweeted me, “Would love your thoughts — Reminders for patients to take their medications are not enough to promote adherence?” I do have a few thoughts. I think this is a complicated situation because probably a lot is going on here. 1) People don’t really want to take medications. They want to be healthy on their own. 2) People can’t always afford the medicines prescribed to them so therefore they are looking for an excuse not to take a medication. 3) They may already feel badly and taking an RX that adds more uncomfortable symptoms to them does not feel like what they want to do. I think this is where their doctor must step in to either help them realize the absolute urgency of taking the drug, maybe eliminating it from their regimen, or find a new one without the uncomfortable side effects. Surely it takes time and patience to achieve this goal, but if it is an urgent matter to take a drug for treatement, this is the approach that is wise and can make sense. I am not a big proponent of big pharma (drug industry), but if drugs are needed, then you are wise to seek out your best one. *There is one caveat to that statement: some people take too many drugs and they interact with each other to produce more side-effects. This is also where their doctor should intervene. Thanks, I’m Cinda Crawford of Get Well Health at http://www.getwellhealth.com.

  2. I agree that adherence is a bigger issue than simply refill reminders. BUT, that shouldn’t be interpreted as refill reminders aren’t needed. They just need to be looked at part of a more holistic strategy.

    You need to consider:
    * Their lack of information in understanding their condition and the drug to begin with.
    * Reminding them to take the medication and refill on time.
    * Understanding their barriers to refilling the medication and helping them address those barriers.
    * Helping them understand the value of staying adherent especially if there are multiple side effects.

    This is a big topic, but as all my clients would tell you, refill reminders are often a cost of doing business AND they work. You get a 5-20 percentage point lift off of them in refill rates which translate into long-term MPR gains.

    George (http://www.georgevanantwerp.com)

    • Michael Wong says:

      Agreed – reminders for those more “committed” to taking their meds, motivating patients who are “not committed”… these are the ones reminders won’t help.

  3. David Delong says:

    The research I’ve done points to patient knowledge about both their disease and their medications as a key component to achieving desired levels of drug compliance and treatment adherence. All too often the physician just tosses a prescription to the patient and that’s where it ends. In the meantime the patient may have no understanding of the side effects for example. A recent example was Tazorac for psoriasis – patients came back after 2 weeks complaining about the burning (that meant it was working) and demanded that the medication be switched. The research is also clear that with each medication switch the chances of adherence go down.

  4. Cheryl Handy says:

    Okay. Time for me to stand on my soapbox. There must (emphasis on must) be a better relationship between physician and patient. And by that I do not mean (with all due respect) the relationship between nurse or paraprofessional and patient. When a patient is concerned about the side-effects of a medication then the patient needs to speak directly with the physician.

    1. Sometimes the medication dose can be adjusted.
    2. Sometimes the patient needs to be reassured that the side-eddects will subside and eventually disappear. Then, the patient needs to be reassessed for side-effects.
    3. Sometimes a different medication can me substituted.

    It is never acceptable that a patient stop a medication on his or her own without consultation with the physician. In some cases, the abrupt withdrawal alone can be life threatening.

    I applaud patients for wanting to be in control of their bodies and lives. But if medication is necessary, the best way to be in control of one’s life is to work as a team directly with the physician.

    Of course, I have awesome ideas for medication compliance, reminders that patients can use themselves (without technology, text messages, phone calls or letters). But we must first address the issue of patients communicating honestly and directly with approachable and cooperative physicians. Medication issues should not be relegated to a nurse or paraprofessional administrative task — lest the patient think he or she can also delegate the decision making to themselves!

  5. complete agree with you on this.
    Young people also “forget” to take their medicine, but its not because they need to be reminded.
    Just the act of taking medication is an inconvenience in and of itself. If you couple that with the multitude of potential side effects that much of medication has, of course people are going to be “fogetful”.
    The medical practice is always a balancing act. Do the means justify the ends? Our goal is first and foremost to do no harm, and it is not always clear cut which action will do the least. We need to consider the fact that quality of life means as much, if not more, than the quantity of life. What is the point of living to 100 if your miserable because of the medication you are on? Not much, if you ask me.
    This is why is so important to ask your patients about how their medications are working for them. Ask them point blank are they taking them and if not, then ask why. Investigate the reasons for noncompliance / non adherence and work together with the patient for solutions without making assumptions or passing judgement.

  6. Michael Wong says:

    @Medikidz (the world’s first and ONLY medical information provider for children) comments:
    “Reminders are helpful but certainly not enough. Patients need to know WHY they’re taking medication and not just be told that they HAVE to.”

  7. I agree with everything said so far, so won’t repeat it. The issue of patiet involvement is deep & wide. Until patients really become engaged in their care in a meaningful way not only will there be lack of medication compliance, but the incidents of misdiagnoses, delayed diagnoses and medical errors will remain higher than they need to be. Most patients don’t know how to tell their story or interact effectively throughout their appointments. Because of this they leave not understanding their condition, medications, etc. Once patient fails to follow recommendations for whatever reason they are usually labelled “noncompliant” in the doctors mind and their chances for a healthy relationship and good care are reduced significantly. Dr. Jerome Groopman explains this very well in his book, “How Doctor’s Think.”

  8. Amos Adler says:

    From our research we’ve determined that simple daily reminders have an effect but wain after 45+/- days. To obtain sustained results, messages need to be most importantly relevant, non-repetitive and take various treatment and patient related factors into consideration. Understanding a patient’s state (stage of change, condition specific psycho-social profile, literacy level etc..), learning style and lifestyle are key in providing them communications and/or reminders.
    Great Blog!
    Amos

  9. At HealthPrize, we’re in violent agreement! We built an online and mobile platform that rewards patients to take their medications. See here: http://www.healthprize.com

    We include education and reminders as well, but we feel that the rewards are essential for boosting opt-in rates and for long-term efficacy.

    Nice post!

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