Patient Compliance with Medications

Issues and Opportunities

Richard Schulz, Christopher Cook, Louis Roller, Jack Fincham, Jenny Gowan

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000083224
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Improve your patient's health through a fresh view of their behaviorsPatients who use over-the-counter (OTC) and prescription medicine often do not take the drugs as intended, sometimes to the detriment to their health and well-being. These widespread problems cause health professionals to agonize over how to try to make sure pati

Chapter 1

Introduction

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom ofthe well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

Susan Sontag, Illness As Metaphor (1977)

Illness is often difficult for all of us, and usually the response to illness is individual specific. Most patients are willing to do all that is possible to obtain an optimum health status. For those that wish to get well or stay well, patient compliance can enhance the potential patients have to achieve health objectives and goals. Patients face abe-wildering array of challenges in the health care system, their health conditions, and necessary actions to obtain or maintain optimal health. Illness affects many; no one is spared in one way or another.

One necessary requirement for many for obtaining a better state of health is the taking of a prescribed or an over-the-counter (OTC) medication for treatment purposes. The use of drugs as a form of medical treatment in the United States is an enormously complex process. Individuals can purchase medications through numerous outlets. Over-the-counter (OTC) medications can be purchased in pharmacies, grocery stores, supermarkets, convenience stores, via the Internet, and through any number of additional outlets. Prescriptions can be purchased through traditional channels (community chain and independent pharmacies), from mail service pharmacies, through the Internet, from physicians, from health care institutions, and from elsewhere. The monitoring of the positive and negative outcomes of the use of these drugs, both prescription and OTC, can be disjointed and incomplete.

External variables may greatly influence patients and their drug-taking behaviors. Coverage for prescribed drugs allows those with coverage to obtain medications with varying cost-sharing requirements. However, many do not have insurance coverage for drugs or other health-related needs. It has been estimated that for the two-year period between 2002 and 2003, 44.7 million individuals (18 percent of the population) under the age of 65 were without health insurance (Kaiser Family Foundation, 2004; Miller, 2001). Certainly, these considerations have huge ramifications for how and when consumers obtain prescribed and OTC medications. Whether they have coverage or not for prescription drugs, patients may choose to be noncompliant. It is much more complex than just consideration of insurance coverage.

Everyone talks about it, all benefit from it, and no one knows as much as what is necessary about patient compliance. Compliance, or lack thereof, affects us all. One of the most understated problems in the delivery of health care services is patient noncompliance, its occurrence, impacts upon it, and associated outcomes if allowed to continue without intervention. Health professionals need to see influencing patient compliance as a required role obligation. The goal of the text will be to present means for health professionals to assume ownership of the issue of noncompliance with medications for the patients for whom they provide care.

This book seeks to explore compliance behavior, impacts (positive or negative) upon it, and opportunities that exist for influencing noncompliant behavior. Thus the issue of noncompliance will be explored with the intent of examining opportunities for improvement and maintenance of compliant behavior with prescribed drugs.

The issues related to compliance will not be solved with the publication of this book. Only through the empowering of patients, and working with those who are not optimally compliance, will success be achieved. The reality of the situations is such that the problems of patient noncompliance must be solved one patient at a time.

REFERENCES

1. Kaiser Family Foundation (2004). The uninsured and their access to health care. Washington, DC: Fact sheet #1420-06, November, 2004.
2. Miller, J. L. (2001). A perfect storm: The confluence of forces affecting health care coverage. Washington, DC: National Coalition on Health Care.
3. Santag, S. (1977). Illness As Metaphor. New York: Farrar, Straus and Giroux.

Chapter 2

Scope of Noncompliance and Other Issues

Patient compliance with medicationsfend regimens is a part of the process of drug use by patients. The prescribed drugs that patients take can be a small part of total drug use by patients. Other drugs taken may include over-the-counter (OTC) drugs, herbal supplements, vitamins, nutritional supplements, and perhaps drugs borrowed from other friends, family members, or perfect strangers. This book relates to compliance and patients, and how to improve the former for the benefit of the latter. However, it is important to consider other aspects of drug use, both prescription and other types of drugs. Elsewhere in this book, specifics about health professionals and impacts upon patient compliance will be presented; pharmacists and their role in compliance are discussed in this chapter.

Drugs, Pharmacists, and Insurance

Drugs As a Form of Treatment

The use of drugs as a form of medical treatment in the United States is an enormously complex process. Individuals can purchase medications through numerous outlets. Over-the-counter (OTC) medications can be purchased in pharmacies, grocery stores, supermarkets, convenience stores, via the Internet, and through any number of additional outlets. Prescriptions can be purchased through traditional channels (community chain and independent pharmacies), from mail service pharmacies, through the Internet, from physicians, from health care institutions, and elsewhere. The monitoring of the positive and negative outcomes of the use of these drugs, both prescription and OTC, can be disjointed and incomplete.

Pharmacies and Pharmacists

It is important to realize that although pharmacists are the gatekeepers for patients to obtain prescription drugs, patients can obtain prescription medications from other pharmacies and/or from dispensing physicians. Patients may also borrow from friends, relatives, or even casual acquaintances. In addition, patients obtain OTC medications from physicians through prescriptions, on advice from pharmacists, through self-selection, or through the recommendations of friends or acquaintances. Through all of this, it must be recognized that there is a formal (structural) and informal (word of mouth) component at play. Pharmacists or physicians may or may not be consulted regarding the use of medications. But in some cases, health professionals are unaware of the drugs patients are taking. In addition, herbal remedies or health supplements may be taken without the knowledge or input of a health professional.

As an example, consider the patient medication profiling capability of most pharmacists. Computerization of patient medication records is commonplace in pharmacy. This computerization allows for ease in billing third-party prescription programs, maintenance of drug allergy information, allows for drug-use review, notification of drug interactions, and aids in the meeting of OBRA ’90 requirements. Thus, computerization permits drug-related information to be easily entered, retained, and retrieved. However, OTC medications are rarely entered into such records (one exception may be OTC drugs prescribed by physicians and dispensed through a prescription by pharmacists). This exclusion of a whole class of drugs from the monitoring programs of pharmacy may have a profound effect upon the ability of pharmacists to monitor the drug therapies of their patients. If the patient purchases the OTC medication in the pharmacy, the pharmacist may have an idea of the drugs consumed. However, if the OTC drugs are purchased in a nonpharmacy outlet, the pharmacist is completely in the dark concerning many drugs a patient may be taking . Patients may also utilize numerous pharmacies for varying prescription products, in which case there is no one record repository for all medications patients may be taking.

Insurance Coverage or Lack Thereof

External variables may greatly influence patients and their drug-taking behaviors. Coverage for prescribed drugs allows those with coverage to obtain medications with varying cost-sharing requirements. However, many do not have insurance coverage for drugs or other heal...

Table of contents

• Cover
• Halftitle
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Author
• Contributor
• Chapter 1. Introduction
• Chapter 2. Scope of Noncompliance and Other Issues
• Chapter 3. Drug Therapies Leading to Noncompliant Activity
• Chapter 4. The Costs of Noncompliance
• Chapter 5. Definitions and Measurement of Compliance
• Chapter 6. Models to Evaluate Patient Compliance
• Chapter 7. Methods to Impact Patient Compliance
• Chapter 8. Bridging the Gap Between Provider and Patient Variables: Concordance
• Chapter 9. Ethics of Compliance
• Chapter 10. The Role of Health Professionals in Influencing Patient Compliance
• Chapter 11. Disease State Management in Older Persons with Hyperlipidemia
• Chapter 12. Current and Future Considerations
• Index