Monday 20 October 2014

Failure to take medicine as prescribed costs Irish government millions

Many Irish patients take their medication incorrectly, costing the government millions and contributing to premature death rates.

Ailin Quinlan

Published 19/08/2014 | 02:30

pills isolated on white background
pills isolated on white background
Many Irish patients take their medication incorrectly
Many Irish patients take their medication incorrectly

More than 70pc of us just say we "forgot," but there may be other reasons behind the failure of so many Irish patients to take the medicine prescribed for often severe health conditions.

It's a significant problem, it seems - and not just in Ireland.

Research shows that 'medication non-adherence' is costing EU governments an estimated €125 billion and contributing to the premature deaths of nearly 200,000 Europeans annually.

A newly published study of more than 1,000 Irish adults shows that in 71pc of cases here, forgetfulness is the reason cited by patients for missing their medication.

About 20pc said they didn't need the medication any more, 16pc said it was because they felt better, 5pc reported feeling anxious about potential side-effects, and 4pc said they didn't believe the medication was effective.

Patients with asthma, diabetes and high cholesterol reported the lowest levels of adherence according to the latest research - just 30pc in people with high cholesterol and 31pc in people with asthma or diabetes, while more than 50pc of carers reported that the person they looked after regularly forgot to take their medication.

That's according to the study, A Report on Patient Non-Adherence in Ireland, which was carried out by Pfizer Healthcare Ireland in association with the Irish Pharmacy Union (IPU) and the Irish Patients' Association (IPA).

However, the reason given by the majority - forgetfulness - may just be a way of avoiding the wagging finger, believes Dr Frank Doyle, lecturer in psychology at the Royal College of Surgeons in Ireland, and current chair of the Division of Health Psychology in the Psychological Society of Ireland

"I think we all learn from a young age that, if we don't do something, we say we forgot. It's an easy way out," he says, adding that there's a lot of evidence which shows that many people simply don't like taking their medicine, and, if they don't see an "immediate benefit", will look for a reason not to take it.

Often this reason will be something they believe about the need for, or efficacy of, the medicine, rather than actual knowledge, he explains.

"Most people have what we'd call a common belief about their medication," he says, giving the example of a man who has been prescribed a beta blocker:

"He doesn't take it on Sunday because he doesn't work on Sunday even though he's told the prescription is for seven days."

In this case, says Doyle, the patient's belief is that he's not stressed on Sundays because he's not at work and thus he doesn't need his beta blocker. "It's the difference between knowledge and belief," says Doyle.

This, however, raises the question about the level of understanding among patients about the medication they are taking, says Stephen MacMahon, CEO of the Irish Patients' Association. "Why do you forget? Is it that you don't believe that the medication is important to you? I think it's about not understanding.

"I believe there has to be a reason they're forgetting to take the medicine and I believe there have to be other drivers to this," pointing out that patients with cholesterol have a very poor rate of compliance which may be linked to a lack of understanding about how the medication works.

"They often feel well so they think they don't need the medicine - and they should be warned about this," he declares.

According to the study, 18pc of those surveyed reported they are not fully adherent all of the time - this figure rose to 23pc both in men and in patients under the age of 35.

Of those who sometimes miss their medication, 64pc miss it one or more times a week.

"It's because we think we know better - we think we understand ourselves better than the doctor," comments Doyle.

"The 'beta-blocker man' thinks stress is causing his high blood pressure but the high blood pressure might not really have anything to do with the stress."

Adherence to medication regimes, he believes, is more driven by what a person believes than by what the health care professional is telling them. The problem is, he explains, a health care professional may not always think to ask the specific question about the patient's beliefs. "I believe that people have a belief but don't disclose them because they may not be asked for them."

And, later, if challenged about why they failed to take their medication, many will opt for the easy answer - absentmindedness, he says. "There's no doubt that a lot of people do forget but I don't think it's as high as it is represented. This is why some people will go to the doctor and get a prescription - and then decide it's not required, he says.

"I know of one mother whose child has very bad asthma. She hates giving medicine to her child." As a result, he says, this mother will rarely give the child the 'relieving' inhaler, and, if the child has an attack, will administer the 'preventative' inhaler - but not consecutively.

"However when this person is asked by her healthcare professional, she tells them she is giving the medicine as instructed." Her belief system is stronger than the advice she is being given by professionals, he says. His comments are underlined by research, which found that the most common barriers to adherence are the perception that the medication does not make a difference (44pc) or that the treatment will not prevent further deterioration of their condition (39pc).

Both of these, says the report, can be addressed by appropriate patient education - the study recommends that regular patient review might be required for some patient populations more than others - and in some disease areas more than others to improve adherence.

"We're actually not logical individuals in terms of life in general, and in terms of complying with treatment requirements, often the starting belief about the relationship between the condition and the treatment is illogical," says Doyle, who believes one of the important questions which need to be asked by health care professionals is the issue of the patient's belief system - what he or she thinks caused the illness and what they expect the medication to do for them:

"I think this is the best starting point because if you don't start with their beliefs you're just lecturing them and not targeting or modifying beliefs which may be quite inaccurate."

The study found that patients who were reviewed by their healthcare professionals within the last month tended to have a higher compliance rate with their treatment regime than patients who had longer time intervals between the reviews.

It made a number of recommendations to help improve adherence levels among Irish patients, including personalised interventions to overcome non-adherence, access to training for healthcare professionals, involving the patient in the management of his or her health and increasing the use of memory aids to help patients increase adherence.

However, there may be a far more practical reason why some patients don't take their medication, warns Dr Ray Walley chariman of the GP Committee of the IMO and a GP in North inner city in Dublin - they can't afford it, he says.

"The single biggest reason why patients are not taking their medication in certain parts of the country is the prescription charge, particularly in disadvantaged areas," he told Health & Living.

"I have a patient who does not take the bone-strengthening medication that she needs, purely for financial reasons, and I have other patients who cannot afford their statins."

At €2.50 per item per month, he says, the prescription charge makes medicine unaffordable for some people.

"It's not too long ago that the credit unions said the average discretionary spend for some people at the end of the month was €25," he said, pointing out that a large number of patients who were on medical cards and required chronic care were primarily older people living in disadvantaged areas of the country.

"I am aware that patients have been contacted by the HSE to ask why they are not collecting their prescriptions so the HSE is aware of this because pharmacists are basically contracted and resourced to provide that data and they do."

According to the survey, 76pc of Irish patients claim to have no formal method or system to help them monitor or remind them to take their medicines. Says MacMahon: "This report is another step forward in patient safety by making us aware of the level that Irish patients do not adhere to their prescription medication regimes."

It was evident that all those involved with the patient he said, should play a role in promoting the importance of adhering to prescribed medication." Mr MacMahon had a strong message for patients: "Take your medicines as advised," he declared, adding that he believed healthcare professionals should use every opportunity to ask patients had they taken their medicine.

Rory O'Donnell, President of the IPU pointed out that pharmacists were "ideally placed to tackle non-adherence to medication, by educating patients, helping them make informed decisions about their medicines and supporting them in adhering to their prescribed therapy."

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