Drugs Work Better When They Are Taken
FAME evaluated the ability of a continued pharmacy care program to improve drug compliance among elderly patients being treated for hypertension and cholesterol. The study enrolled men and women 65 years of age or older, who took at least 4 chronic medications each day. First, patients were observed for several months, during which it was found that only 61% on any given day were taking all their prescribed drugs. Patients were then enrolled in a continued pharmacy care program, where there was extensive evaluation and counseling, where individualized measures were instituted to make adhering to the prescribed drug regimen more oonvenient, and in which periodic follow-up was done. At the end of this phase, 97% were taking their drugs appropriately. Finally, patients were randomized to either continue receiving the intensive pharmacy care, or to take drugs on their own. Those remaining in the continuous pharmacy care program still had a 97% rate of compliance; whereas the others reverted to their previous low rate of drug compliance. Patients who remained in the pharmacy care program also had significantly improved blood pressure and cholesterol measures.
All doctors know that patients often don't take their medications as they are supposed to, but the notion that only 61% of patients are taking their drugs on any given day is enough to make even the most cynical healer weep.
Consider the dynamics here. "Ms. Jones, I see your blood pressure is still up. Are you taking your medication?" "Yes, doctor. Oh I might miss a dose here and there, but I take my medicine, all right." Well, then, Ms. Jones, it looks like we have no choice but to increase your dose of Dyn-O-Mite and add some Blast-o-matic for good measure." "Whatever you say, doctor." More drugs, more expense, more side effects, even less compliance.
Two lessons: 1) Human nature is pretty intransigent, not to mention difficult to change. Too bad most of the brilliant solutions medical science dreams up require it to. 2) Some day perhaps we'll become enlightened enough to realize that instituting low-tech but labor-intensive programs, like the pharmacy care program used in FAME, would save lives and money. Until then, when the doctor asks whether you're taking your medication as prescribed, take pains to give an accurate response, lest the doctor feel obligated to resort, with unwitting inappropriateness, to higher and higher doses of more and more powerful chemicals.
Comments
What a great study! But one thing I didn’t understand after reading the FAME paper in JAMA for class-the patients initially all used blister packs in the first phase (after the run-in)-and if they did not take all their medicine they had to painstakingly tape it back into the blister pack. If you were lazy, you would just throw it away, so when your empty blister pack was taken in and any unused pills were counted (this is the primary way that medication adherence was measured), it would seem like you were being compliant, but you were just being lazy. There were a bunch of pills in your garbage can the pill counter never saw. In the second phase, if you were randomly assigned to get your pills back in a bottle, not a blister pack, and you were lazy, you would again not take them, not bother to empty the bottle, and the pill counter would count up your pills left in the bottle (because you were too lazy to take them out) so it would look like you were being less compliant than in Phase 1, although your level of medication adherence and laziness has been consistent throughout the study. This could falsely inflate the value of a blister pack in medication compliance. Was this addressed specifically somehow in the data analysis and did I just miss that?
This is only two weeks later than your posted article, and I hope this may be noted by all cardiiologists, pharmacists, nurses, and whoever has to deal with those damn blister packs. They are absolutely the devil’s invention and impossible for the sick and elderly to manage. I speak as an ‘elderly’ heart failure patient who wonders what the solution can possibly be for those like me who do not always take our morning meds. I am an 86 year old female who struggles daily with not only heart failure but active fibromyalgia and myofascial pain, and sleep deprivation, exhaustive fatigue, and resultant depression. I live alone in an apartment for Retirement Living, with an assisted living facility and 2- stage nursing home facilty, both available when I am ready. But I stay independent in my 2 rooms with 2 cats to keep me company.
The big consolation in the article for me was t0 know that I am not alone in my daily struggles as far as regular taking of my meds is concerned. So sorry it took me so long to say it.
You people do a great job. I am 80 years’ and your are never to old to learn new things’. Keep them coming