The Perils of Prescribed Pill Popping

Check out the highlights from a recent article from Medscape Rheumatology, discussing patient adherence to prescription medications. Taking your meds when and how you're supposed to can be tricky. I even created an excel spreadsheet so that I could track all of my prescriptions. When you're pill popping as much as Lupites have to sometimes, it's impossible to remember what you're taking or when, without writing it down. In the next few days, check back for a sample of my drug journal, fondly referred to as my "Chronic Control" spreadsheet!

Here are the article highlights:

People who are prescribed self-administered medications typically take less than half the prescribed doses. (Can you believe that?!) Many reasons exist for nonadherence to medical regimens. They include problems with the regimen (such as adverse effects), poor instructions, poor provider-patient relationship, poor memory, patients' disagreement with the need for treatment, or patients' inability to pay. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications but also might increase their adverse effects. In this current review of trials of ways to help people follow prescriptions, updated from the 2005 version, 21 new studies were reviewed.

The aim of this study was to update a review summarizing the results of RCTs (randomized controlled trials) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions.

Study Highlights
Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% of follow-up of each group studied and, for long-term treatments, at least 6 months' follow-up for studies with positive initial findings.

The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes; therefore, a qualitative analysis was performed.

For long-term treatments, 36 of 81 interventions reported in 69 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least 1 treatment outcome.

Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. This implied that more frequent interaction with patients with attention to adherence may be needed.

Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes.

What's this all mean? It's up to you to make sure you take your meds when and how you're supposed to. The drugs designed to make you feel better aren't going to do you any good if you don't take them, take them too close together (or too far apart), or combine them with other substances that counteract their effects. Follow your doctor's orders to a "T", read the information packet that comes with your prescriptions, and you'll be that much closer to finding a drug combo that works for you.