Medication Adherence and Heart Patients

Really, how important is it to maintain adherence to your medication profile?

I have a friend whose heart stopped beating due to a massive heart attack over ten years ago. His wife found him unresponsive, called 911 and performed CPR on him until the paramedics arrived. He was taken to the hospital for an extended stay in the intensive care unit where doctors and nurses performed multiple procedures, infused him with many different medications and monitored him constantly in an effort to stabilize his now beating heart. When discharged from the hospital, my grateful friend did one important thing; he followed his doctor's directions.

1.       First of all, he quit smoking. He had smoked daily and regularly for many years. He has not smoked a single cigarette since he left the hospital.

2.       He signed up with a health club, and began a regular course of aerobic and resistance training.

3.       He followed his doctor's orders about taking his new medications.  He is 100% adherent to his medication profile.

So, why is adherence important?

·         Adherence is described as "the degree to which patients correctly follow prescription instructions."

·         The most recent adherence statistics state that:

·         Of the over 3.2 billion prescriptions (yes, 3.2 billion) dispensed each year in the United States, over half are non-adherent.

·         An astounding 32 million Americans use 3 or more medications on a daily basis.

·         Over 75% of adults are not adherent in one way or another to their medication.

·         Mortality data shows that over 125K deaths per year in United States are related to non-adherence to medication therapy.

·         Estimates show that over 69% of all medication related hospital admissions and 40% of all medication related nursing home admissions are due to medication adherence issues.

·         So again, why is adherence important, well, the best estimates put the cost of non-adherence at somewhere between 100 and 300 billion dollars per year.  Now those are some significant health care dollars!

Now, why, specifically, is adherence important with cardiac patients?

·         The 10/13 issue of the American Heart Journal reviewed the medication adherence in post-heart attack patients.

·         Most medication adherence studies review WHY patients are non-adherent to their medication profile.  This study was different. 

·         This particular study examined the long term clinical outcome of the patients compared to how often they were adherent to their medications.

·         The results are more than convincing.  This study shows that post-heart attack patients, who are at least 80% adherent to their medications, are significantly more likely to have a long term positive outcome of therapy.

·         So, with results like these, why would anyone not be adherent to their medications?

There are many different barriers to medication adherence, here; we will discuss a few of the most common.

·         COST of medications:  Yes, many medications are expensive.  What happens is a patient cannot afford their medication and then decide on their own that it is better to take it every 2 or 3 days and save some money rather than not take the medication at all.  Then, a couple months go by and they may just stop all together.  Please, talk to you pharmacist or doctor.  Quite often there is a generic medication that is much less expensive that your doctor may feel appropriate in this particular situation.   Your pharmacist will be happy to discuss the situation with your doctor or insurance company.

·         Forgetfulness:  WOW, the idea of going from not taking any medications to taking 3 or more medications up to 3 times daily is a huge issue.  Again, take a moment and ask your pharmacist what recommendations they may have for you on how to organize your medications in order to help you maintain adherence.

·         HEALTH LITERACY:  The ability to explain your diagnosis, what you are doing to treat it, and the consequences of not treating it.  A recent study in the New England Journal of Internal Medicine described that over 72% have some limitation in their health literacy.  Over half of these patients were not adherent to their medications.  Why would you think you need to take your medication if you don't understand why you are taking it, how it works, and what will happen if you don't take it?

Again, talk with your pharmacist.  Your community pharmacist is a valuable Medication Information and Health Literacy resource.  The 3/14 issue of Consumer Reports wrote an article titled "The top 10 reasons you may want to change pharmacies".  The number one reason was to make sure you were able to establish a relationship with a pharmacist.

Do yourself a favor and visit three or four local pharmacies. Include an independent pharmacy, chain store, supermarket and big box retail store. Stand back and watch the pharmacy for 5 or 10 minutes and take in what you see. Do the pharmacists look like they have enough time do the work in front of them, is there a patient counseling area that appears relatively private, are the clerks at the front counter pleasant with the customers, and how many patients are in line or waiting for their prescriptions?

Next, step up to the counter and ask to speak with the pharmacist. Explain to the pharmacist that you are considering transferring prescriptions to their store and you would like to know what sort of service they offer. Believe me; if you visit four different pharmacies and follow through with this little exercise, you will have a clear idea of which pharmacy is the one for you.


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