House Calls / Dr. Michael Schwartz

Noncompliance is a major problem in medical care. Unfortunately, it is common for patients to not take their medications as prescribed. Many miss doses while some run out of their medication and fail to go to the pharmacy for a timely refill. Even more common and concerning are patients who fail to follow-up with their physician after being on a specific medicwation despite specific directions to do so.

Medications are administered in many different ways and may require multiple dosing; some as frequently as every two hours. Whether orally (by pill or liquid), inhalation, topically or via injection, it is estimated that upwards of 50 percent of patients are noncompliant. For some patients, compliance is difficult, since they are prescribed many different pills throughout the day. Studies have shown that medications requiring once or twice daily dosing tend to have good compliance, but that percentage drops significantly with more frequent dosing requirements. In addition, the more medications one takes, the less compliant they tend to be.

Poor compliance can be the result of several issues. It is more common when the medication a patient takes does not have an objective effect on his disease. For example, if a patient has hypertension, taking blood pressure medications typically will not have an immediate effect on howw they feel. However, if a patient has indigestion they are more likely to be compliant since they will have immediate adverse symptoms of their disease if they even miss one dose. Memory issues, psychiatric disorders, adverse side effects and age also play an important role. Finally, cost has been a major issue with compliance since it is difficult for many patients to afford their prescriptions.

Pharmaceutical companies and local pharmacies are obviously concerned about compliance as they lose billions of dollars each year if patients miss medication doses. Some insurance providers actually encourage pharmacies to be more proactive in notifying consumers that they are due for a medication refill.

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Although medications cost insurance providers billions of dollars each year, there is a significant cost benefit for those patients who take their medications as directed. Consequently, the cost of noncompliance is higher in emergency room visits, expensive hospitalizations and the need for additional medication therapies for unnecessary illnesses.

As such, these companies are all working on ways to improve adherence to medication regimens and patient outcomes. For example, United Health Care recognizes pharmacies that assist their patients in compliance and makes a donation to charities in their honor.

The emergence of the "patient-centered medical home" improves patient compliance in all aspects of their medical care. Eileen Smith, executive director of Soundview Medical Associates (a practice recognized as a patient-centered medical home in Norwalk) stated, "Patients are encouraged to make an annual exam appointment with their primary care physician and we call each patient to make sure they schedule one if they have not already done so. If we either cannot reach the patient or schedule the exam, we assess what is the barrier to care and try to resolve it. Soundview Medical also follows clinical guidelines based on nationally recognized recommendations. These recommendations are built into the patient's electronic medical record, so the physician can quickly see what services the patient needs for their individual care."

There are many ways to improve medication compliance:

Use weekly pill dispensers which can be filled at the beginning of each week. Many elderly patients will have friends or relatives come in each week to refill the dispensers and confirm that the medications were taken from the week before.

Use alarm notifications on your smartphone.

Download a medication compliance application on your smartphone or computer. Some even reward prizes for good compliance. Many are free and most are easy to use regardless of age or technical savvy.

Simply keep your medications next to your toothbrush to remind you to take your pills when you brush their teeth in the morning and evening. Keep small Dixie cups near the medications to simplify the process.

You may receive a call from your physician's office if your medications are not being renewed in a timely fashion. Some new electronic medical record programs are designed to notify physicians if patients are not compliant.

If you are having trouble affording your medications, discuss this with you physician. He or she may be able to prescribe an alternative drug. Coupons are available for many medications and can be found online or at your doctor's office. It is imperative that you never abruptly stop a medication prescribed by your physician. If you are running low, contact your doctor.

Noncompliance with medications can lead to many adverse health consequences. Billions of medical dollars are wasted each year on worsening disease based on missed doses.

Sadly, many patients end up in the hospital for preventable illnesses. More importantly, lives are lost when patients are not compliant with treatment regimens. Further cooperation is needed between physicians, patients, pharmacies and health insurers to promote health and wellbeing. A fully integrated approach is the key.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at