Taking medication correctly may seem like a simple or personal matter, but non-adherence (or not taking medication as directed) is a complicated and common problem.
The treatment of chronic illnesses commonly includes the long-term use of medications. Diseases like Diabetes or Heart disease may require long term medication. Although these medications are effective in combating disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed.
Gwen Egloff, PharmD is here to explain the importance of taking, as prescribed, all your medications.
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Taking Medications on Time: More Important Than You Might Think
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Learn more about Gwen Egloff, PharmD
Gwen Egloff, PharmD
Gwen Egloff, PharmD, BCPS, specializes in pharmacotherapy. Prior to joining Summit Medical Group, she was a clinical staff pharmacist and PGY-1 General Practice Pharmacy Residency Preceptor at Saint Barnabas Medical Center in Livingston, NJ. She has also served as a Rutgers Pharmacy Student Preceptor. Dr. Egloff is a member and the annual meeting committee chair of the New Jersey Society of Health-System Pharmacists.Learn more about Gwen Egloff, PharmD
Transcription:
Taking Medications on Time: More Important Than You Might Think
Melanie Cole (Host): Taking medication correctly may seem like a simpler, personal matter, but non-adherence, or not taking medication as directed, is a complicated and common problem. My guest today is Dr. Gwen Egloff. She's an ambulatory care clinical pharmacist specializing in pharmacal therapy at Summit Medical Group. Welcome to the show, Dr. Gwen. So, let's talk about medication adherence. What exactly is that and what do you see as the biggest issue with non-adherence?
Dr. Gwen Egloff (Guest): Well, thank you for having me on today, Melanie. So, medication adherence is the extent to which a patient's behavior--whether that behavior be taking a medication or following lifestyle recommendations--corresponds with agreed upon recommendations from a healthcare provider. Non-adherence is an extraordinarily complex issue. The greatest concern with non-adherence is that it's directly linked to worse outcomes. Non-adherent patients are more likely than their adherent counterparts to have adverse health events that incur additional cost to both the patient as well as our healthcare system. To give you an idea of the magnitude of medication non-adherence, over a quarter of new prescriptions are never filled. Additionally, half of patients don't take medications as directed by their provider. Non-adherence is the cause of up to 50% of treatment failures and accounts for 125,000 deaths annually, not to mention that it costs $300 billion per year, so this is a truly significant issue.
Melanie: Okay. So, what populations seem to be affected the most? We hear about seniors and all the various medications that they're on. So, what populations are you talking mostly about?
Dr. Egloff: That's an excellent point. So, adherence does vary from patient to patient and some of those variables known to impact adherence are based on particular disease states, co-morbid conditions, medications, how much those medications cost, how long the patients have been on therapy, their age, and personal beliefs. The greatest predictor of adherence is truly evaluating a patient's adherence to previous therapies. Some additional factors that have been shown to impact adherence are also the lack of follow up from providers and side effects that patients experience. But, it truly depends on how the patient perceives that medication and their disease state. Patients that take medications aimed at prevention, where they may not feel an effect from that therapy, actually exhibit lower adherence.
Melanie: Well, that would make sense. And so, when we're talking about different medications, what are some meds that are more important--I mean, they're all important and they're all important for prevention and for treatment of chronic disease--but what are some of the ones that you would say are much more important to keep on a timely schedule, like insulin or diabetes medication, those types of things?
Dr. Egloff: That's an excellent point as well. So, again, diabetes medications are one that we want to keep on a strict schedule depending on when a patient eats and when they take their long-acting insulin therapies. Some other medications that come to mind are medications that need to be taken with or without food, or at certain times of the day. So, some medications that need to be taken without food are those thyroid medications that need to be taken first thing in the morning, 30-60 minutes before a patient eats. Other medications should be taken with food, to either reduce stomach upset. We think of antibiotics or some medication should be taken with food because it actually helps the medication to work better. The last point that I want to make is that some medications need to be taken at certain times of the day and we think about some cholesterol medications that work best if taken at bedtime, but this is why it's so important to speak with your pharmacist- to make sure that you're getting the most out of your medications; making sure that you're taking them correctly, with or without food, and at the right time of day.
Melanie: So, what are some tips you like to recommend that will keep people on that medication? Because we've seen the pill boxes, Dr. Gwen, we've seen you know, the reminders, the medication minders and, even now, with technology, there are little alarm bells that can go off that tell you. What do you tell people as a great way to remember when and to take their medications?
Dr. Egloff: Absolutely. So, therapies, as you had mentioned, are only effective if they're taken. Therefore, medication adherence needs to be assessed at every visit by the provider, and providers can use things like open-ended questions and adherence scales to try and get an idea of how often their patients are taking their medications. It's important to keep in mind that no "one size fits all" approach will work but solving medication non-adherence requires these techniques, as well as multiple techniques and multiple healthcare providers to work together to make sure that the patients are getting the most of their therapies. The first and most essential step that I take when speaking with patients is try to identify those barriers and determine why the patient's being non-adherent. Although some patients are non-adherent because they forget to take their medications, some patients choose not to take their medications, and for various reasons. By determining why a patient is non-adherent, we can truly figure out those tips and techniques that will work best for them. So, for my patients that are having trouble affording their medications, we can look at substituting to generically-available options, or looking into patient assistance programs. There's also the potential to use combination products, where a patient takes one pill that contains more than one medication, and that can help to reduce the complexity of regimens. We can also use 90-day prescriptions as well as medication synchronization that allows the pharmacy to fill all the medications on the same day and that reduces the number of trips that the patient needs to take to the pharmacy. For those patients who just don't want to take their medications, as healthcare providers, we need to truly get them involved in developing their treatment plan, offering both medication and non-medication-related options, educating patients on what's the benefit and what are the side effects of each individual option? And, utilizing teach packs to make sure that patients understand what the medication is for, what to do if they have a side effect and how to long to anticipate to take this medication in the long-term.
Melanie: Dr. Gwen, one of the reasons that I've seen over the years for non-adherence, is the side effects. You mentioned people are afraid of those, they see in the media "side effects may include . . ." blah, blah, blah, and, in the medication packet is this long, unfolding list of side effects, and some people--it just terrifies them; whether it's a statin that they're taking or something else. What do you tell them about that tiny, little writing that lists all those side effects as a reason for not taking their medication?
Dr. Egloff: What an excellent point. So, like you had mentioned, there are laundry lists of side effects that need to be reported within the package insert of these medications. It's truly important for the health care provider to take a look at the clinical significance of each side effect and then share with the patients what are those clinically-significant side effects that they could potentially experience and, not only what are those side effects, but how they should manage them. If a patient takes a medication and gets an upset stomach, should they take it with food next time? Should they stop taking the medication? Should they call the provider? Healthcare providers need to work up a plan for patients so that patients know when they leave the office what they should do and that makes patients more willing to take their medications.
Melanie: Great explanation. So, in just the last few minutes, kind of wrap it up with your best advice on medication adherence, the importance of it and why they should come to Summit Medical Group for their care.
Dr. Egloff: Absolutely. So, like I had mentioned, medication adherence is a huge issue because it's directly linked to those worse outcomes. We need to work as a team--not only as healthcare providers but as a team with the patient to make sure that the patient is getting the most out of their medication regimen. Here at Summit Medical Group, I'm an ambulatory care clinical pharmacists and I work directly with patients, helping to improve their medication adherence and working with them based on their barriers and what difficulties they're having, because again, there is no "one size fits all" approach. So, we need to work as a healthcare team with the patient to make sure that their unique medication regimen works for them and that they're getting the biggest benefit out of it.
Melanie: What great advice. Thank you so much, Dr. Egloff, for being with us today. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That's summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Taking Medications on Time: More Important Than You Might Think
Melanie Cole (Host): Taking medication correctly may seem like a simpler, personal matter, but non-adherence, or not taking medication as directed, is a complicated and common problem. My guest today is Dr. Gwen Egloff. She's an ambulatory care clinical pharmacist specializing in pharmacal therapy at Summit Medical Group. Welcome to the show, Dr. Gwen. So, let's talk about medication adherence. What exactly is that and what do you see as the biggest issue with non-adherence?
Dr. Gwen Egloff (Guest): Well, thank you for having me on today, Melanie. So, medication adherence is the extent to which a patient's behavior--whether that behavior be taking a medication or following lifestyle recommendations--corresponds with agreed upon recommendations from a healthcare provider. Non-adherence is an extraordinarily complex issue. The greatest concern with non-adherence is that it's directly linked to worse outcomes. Non-adherent patients are more likely than their adherent counterparts to have adverse health events that incur additional cost to both the patient as well as our healthcare system. To give you an idea of the magnitude of medication non-adherence, over a quarter of new prescriptions are never filled. Additionally, half of patients don't take medications as directed by their provider. Non-adherence is the cause of up to 50% of treatment failures and accounts for 125,000 deaths annually, not to mention that it costs $300 billion per year, so this is a truly significant issue.
Melanie: Okay. So, what populations seem to be affected the most? We hear about seniors and all the various medications that they're on. So, what populations are you talking mostly about?
Dr. Egloff: That's an excellent point. So, adherence does vary from patient to patient and some of those variables known to impact adherence are based on particular disease states, co-morbid conditions, medications, how much those medications cost, how long the patients have been on therapy, their age, and personal beliefs. The greatest predictor of adherence is truly evaluating a patient's adherence to previous therapies. Some additional factors that have been shown to impact adherence are also the lack of follow up from providers and side effects that patients experience. But, it truly depends on how the patient perceives that medication and their disease state. Patients that take medications aimed at prevention, where they may not feel an effect from that therapy, actually exhibit lower adherence.
Melanie: Well, that would make sense. And so, when we're talking about different medications, what are some meds that are more important--I mean, they're all important and they're all important for prevention and for treatment of chronic disease--but what are some of the ones that you would say are much more important to keep on a timely schedule, like insulin or diabetes medication, those types of things?
Dr. Egloff: That's an excellent point as well. So, again, diabetes medications are one that we want to keep on a strict schedule depending on when a patient eats and when they take their long-acting insulin therapies. Some other medications that come to mind are medications that need to be taken with or without food, or at certain times of the day. So, some medications that need to be taken without food are those thyroid medications that need to be taken first thing in the morning, 30-60 minutes before a patient eats. Other medications should be taken with food, to either reduce stomach upset. We think of antibiotics or some medication should be taken with food because it actually helps the medication to work better. The last point that I want to make is that some medications need to be taken at certain times of the day and we think about some cholesterol medications that work best if taken at bedtime, but this is why it's so important to speak with your pharmacist- to make sure that you're getting the most out of your medications; making sure that you're taking them correctly, with or without food, and at the right time of day.
Melanie: So, what are some tips you like to recommend that will keep people on that medication? Because we've seen the pill boxes, Dr. Gwen, we've seen you know, the reminders, the medication minders and, even now, with technology, there are little alarm bells that can go off that tell you. What do you tell people as a great way to remember when and to take their medications?
Dr. Egloff: Absolutely. So, therapies, as you had mentioned, are only effective if they're taken. Therefore, medication adherence needs to be assessed at every visit by the provider, and providers can use things like open-ended questions and adherence scales to try and get an idea of how often their patients are taking their medications. It's important to keep in mind that no "one size fits all" approach will work but solving medication non-adherence requires these techniques, as well as multiple techniques and multiple healthcare providers to work together to make sure that the patients are getting the most of their therapies. The first and most essential step that I take when speaking with patients is try to identify those barriers and determine why the patient's being non-adherent. Although some patients are non-adherent because they forget to take their medications, some patients choose not to take their medications, and for various reasons. By determining why a patient is non-adherent, we can truly figure out those tips and techniques that will work best for them. So, for my patients that are having trouble affording their medications, we can look at substituting to generically-available options, or looking into patient assistance programs. There's also the potential to use combination products, where a patient takes one pill that contains more than one medication, and that can help to reduce the complexity of regimens. We can also use 90-day prescriptions as well as medication synchronization that allows the pharmacy to fill all the medications on the same day and that reduces the number of trips that the patient needs to take to the pharmacy. For those patients who just don't want to take their medications, as healthcare providers, we need to truly get them involved in developing their treatment plan, offering both medication and non-medication-related options, educating patients on what's the benefit and what are the side effects of each individual option? And, utilizing teach packs to make sure that patients understand what the medication is for, what to do if they have a side effect and how to long to anticipate to take this medication in the long-term.
Melanie: Dr. Gwen, one of the reasons that I've seen over the years for non-adherence, is the side effects. You mentioned people are afraid of those, they see in the media "side effects may include . . ." blah, blah, blah, and, in the medication packet is this long, unfolding list of side effects, and some people--it just terrifies them; whether it's a statin that they're taking or something else. What do you tell them about that tiny, little writing that lists all those side effects as a reason for not taking their medication?
Dr. Egloff: What an excellent point. So, like you had mentioned, there are laundry lists of side effects that need to be reported within the package insert of these medications. It's truly important for the health care provider to take a look at the clinical significance of each side effect and then share with the patients what are those clinically-significant side effects that they could potentially experience and, not only what are those side effects, but how they should manage them. If a patient takes a medication and gets an upset stomach, should they take it with food next time? Should they stop taking the medication? Should they call the provider? Healthcare providers need to work up a plan for patients so that patients know when they leave the office what they should do and that makes patients more willing to take their medications.
Melanie: Great explanation. So, in just the last few minutes, kind of wrap it up with your best advice on medication adherence, the importance of it and why they should come to Summit Medical Group for their care.
Dr. Egloff: Absolutely. So, like I had mentioned, medication adherence is a huge issue because it's directly linked to those worse outcomes. We need to work as a team--not only as healthcare providers but as a team with the patient to make sure that the patient is getting the most out of their medication regimen. Here at Summit Medical Group, I'm an ambulatory care clinical pharmacists and I work directly with patients, helping to improve their medication adherence and working with them based on their barriers and what difficulties they're having, because again, there is no "one size fits all" approach. So, we need to work as a healthcare team with the patient to make sure that their unique medication regimen works for them and that they're getting the biggest benefit out of it.
Melanie: What great advice. Thank you so much, Dr. Egloff, for being with us today. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That's summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.