August 10, 2007
Associated Press

Latest Drug Crisis: People Not Taking Their Medicine

By Lauran Neergaard

Consider it the other drug problem: Millions of people don't take their medicine correctly - or quit taking it altogether - and the consequences can be deadly.

On average, half of patients with chronic illnesses such as heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week that calls the problem a national crisis costing billions of dollars.

The government is preparing new steps to try to persuade patients and their doctors to do better.

But with contributors that range from too-hurried doctor visits to confusing pill bottles, there is no easy solution.

"We go into this with some humility," says Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an "in-your-face" campaign to improve medication adherence.

"It's really pretty appalling how badly we do."

This goes far beyond the issue of affording prescriptions. Often, people buy their drugs but misunderstand what they're supposed to take, or how. Or forget doses. Or start feeling better and toss the rest. Or skip doses for fear of side effects.

Even the rich and highly educated skip their medicine. A high-profile example is former President Bill Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery. Statins offer significant heart protection, but about half of patients on statins, which can have significant side effects, quit within a year.

The new report combs a decade of research and concludes that people generally do a lousy job taking meds.

Among the National Council on Patient Information and Education's findings:

Particularly at risk are people whose diseases are initially symptom-free. Although high blood pressure more than triples the risk of heart disease, for example, just 51 percent of patients stick with their prescribed antidote.

Also at high risk are the elderly, but adherence is a problem for all ages. As few as 30 percent of teenagers correctly take drugs to prevent asthma attacks, for example.

Dire consequences aren't always a deterrent. Among patients already blind in one eye from glaucoma, only 58 percent were protecting the other eye. Another study found 18 percent of kidney-transplant recipients were not following instructions to prevent organ rejection.

Even doctors mess up, conceding in one study adhering to their own prescriptions just 79 percent of the time.

Poor medication adherence can cost an extra $2,000 a year per patient in extra doctor visits alone. It is also associated with up to 40 percent of nursing-home admissions.

Add preventable hospitalizations and premature deaths, and the report estimates that poor medication adherence could be costing the country $177 billion in medical bills and lost productivity.

Why is taking medicines correctly so tough?

One reason is general confusion surrounding drugs, says Ruth Parker of Emory University, a coauthor of the new report, who has studied the issue for the American College of Physicians Foundation.

Pharmacy prescriptions have bunches of papers - stapled to the bag, outside the box, glued to the bottle - that all bear drug information, but often with different wording. Bottles are covered in warning stickers - such as "Take with food" or "Swallow whole" or "Don't use with XYZ" - in so many colors that Parker compares pill containers to Christmas trees.

Then there's the wording. Parker recently helped test the seemingly simple instruction "Take two tablets twice daily." Did that mean a total of two, or a total of four? A third of patients deemed literate got confused. A clearer instruction would be: "Take two tablets in the morning and two tablets at night."