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A report by the National Council on Patient Information and Education published in August 2007 is focusing attention on a drug problem in this country that is seldom discussed. Millions of Americans are failing to take their medications as prescribed, resulting in serious health consequences for the patient, and costing billions of dollars in follow-up care.
The problem with patients understanding how to take their prescribed medications is apparently not new; and no one knows that better then Michael Wolf, Ph.D., assistant professor of medicine at Northwestern University's Feinberg School of Medicine, and co-author of a 2006 study on the subject. In the University’s press release about his research, Wolf told an anecdote about paging through pharmacists' logs from the 1890s at the Smithsonian National Museum of American History, and finding the following notation about a verbal exchange between a druggist and a confused patient: “Shake well,” a patient read out loud to the pharmacist from his prescription bottle label. “Does that mean I shake myself?”
While the anecdote may cause a chuckle or two, the results of Wolf’s study are far from amusing.
He and co-lead author Terry Davis, a professor at Louisiana State University, studied 395 patients ranging in age from 18 through their mid-70s who were from primary care clinics serving indigent populations in Chicago; Shreveport, Louisiana; and Jackson, Michigan. What they found was that almost half of the patients in the study misinterpreted at least one or more out of the five prescription labels they were asked to read. Patients with low literacy made the most mistakes and in most instances, they were unable to understand four out of five label instructions. But even people with a high-school education and higher had problems.
Josef Schenker, M.D., Director of Pre-Hospital Care for Emergency Medicine at New York Methodist Hospital, would agree with Wolf that failure to take mediation correctly is a widespread problem. He had some other very specific reasons for the problem. “Some people aren’t given good instructions by their doctors. Some people just don’t understand the need to take a specific medication at a specific time. Drug regiments are complicated, especially with some of the advanced medications.”
He said a good example of the way people ignore dosage instructions is in the use of antibiotics. A doctor prescribes antibiotics for ten days, but you start to feel better and you don’t continue to take the medication, as you should. You might not think this is such a big thing, but the consequence of not following dosage instructions is antibiotic drug resistance. “The less virulent bugs, Dr. Schenker said, are the easiest to kill, and the medication targets those. If you don’t complete the medication, the more virulent bugs build a resistance, and the next time you take the medication, it doesn’t work as effectively.”
Another common dosage mistake is not taking all of your medication and saving it if you get sick again. Dr. Schenker said, “Medications lose efficacy over time. Just because you don’t feel well, you may not need that medication. If you take it without needing it, that also contributes to drug resistance.”
Dr. Schenker said that your doctor should know all the medications you are taking, because no one wants to prescribe medications that will negatively interact with one another. He added that some medications may increase the length of time another medication remains in your body. “If there are two keys and one lock, only one key can be put in the lock at a time.” The same is true with your prescriptions. If both medications are using the same pathway, then only one will work as intended, and the other will simply remain in the body longer. This is also true for how effectively the drugs work.
Finally, if you are using prescription medications for long-term care of a condition like diabetes or high blood pressure, and you aren’t taking your medications properly, you aren’t controlling the condition. Instead, what you are really doing is adding the negative effect of the disease to all the systems of your body.
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