Results of a recent study by Quest Diagnostics found that more than half of adults and 44% of children misused their prescription medications.
Results of a recent study by Quest Diagnostics found that more than half of adults and 44% of children misused their prescription medications. ‘Misuse of medications’ was defined as taking too much, too little, or none of their medication—a broad definition. And physicians are not surprised by the study’s results.
“There’s such confusion right now in the pharmacy world,” says Allen Taylor, MD, FACC, FAHA, chief of cardiology of Medstar Heart and Vascular Institute. “There are a lot of therapies, evidence on them varies, and co-pays are fluctuating. It’s a Rubik’s Cube of issues as to why patients don’t take medications as correctly as we’d like them to.”
Susan Nedza, MD, senior vice president of clinical outcomes for MPA Healthcare Solutions in Chicago, agrees. She says that as an emergency room physician she’s taken care of patients who misused their medication under all three aspects of the above definition.
“I’m not surprised at all,” says Nedza, regarding the study results.
Inside the numbers
The doctors agree there are many factors contributing to patient misuse of medication. One of the leading elements is cost. Nedza says patients will often get to the pharmacy with good intentions to fill their prescription, only to find out they can’t afford it.
“We’ve even seen the price of generic drugs go up,” she says. “Some of these medications that used to be a couple of dollars per pill are now $150 per pill. That’s problematic.”
Taylor says that in addition to cost, medication regimens are often complex and difficult for patients to understand. There are also side effects, which generate a belief on the part of the patient that they may not be getting any benefit from the medication.
“That's why one of the ways to improve adherence is to begin medication in the hospital when patients that are hospitalized,” Taylor says. “That's when therapies are initiated.”
Self-diagnosing is also an issue, brought about at least in part by the overabundance of information available online. Nedza explains that many patients will default to homeopathic remedies, or something a friend or family member told them about.
“The perfect example of that is people use garlic instead of their high blood pressure pills, because they heard garlic is good for your blood pressure,” she says. “But the supplement industry is not regulated.”
Value of education
Education is critical, and both Taylor and Nedza agree physicians play an important role in that regard.
“It’s ongoing education,” Taylor says. “Reinforcing the benefits, and confirming that they continue to need the medication.”
Nedza says one area that is problematic is at discharge from the hospital. Patients are given their medications, but they often have other medications at home. She says there’s a 20% risk of patients having an adverse outcome within the first 48 hours after discharge.
“If you’re a surgeon and you’re operating on a patient, there’s an important follow up call to be made within 48 hours to see how the patient is,” she says. “Having a routine in place to call, and not assuming [the patient] is going to follow up with their primary care doctor, is really important.”
Taylor echoes that thought. He says there are many barriers patients might face in being able to take a medication as prescribed. He encourages physicians to ask, “If I write this prescription, are you going to take the medication?” And have the patient teach back what you just told them about the medication.
“I think an under-recognized role of the physician is to monitor when medicine should be stopped; when medicines no longer have benefits,” Taylor says. “A patient is seeing a primary care physician and four specialists, they’re writing prescriptions, and the next thing you know you’ve got a toxic mixture of too many medicines with too many interactions, and too much cost for a patient to manage. And it unravels.”
There is a clear benefit to helping patients avoid medication misuse, but there’s also an important financial factor. Taylor explains that medication is a big part of reimbursement related to readmissions.
“It isn’t exactly a direct cost,” he says. “You don’t see it in the bottom line, but people will begin to see it and experience it more in their value-based payments and under the current reimbursement models.”
Nedza says that one emergency department visit, even an urgent care visit and certainly a readmission, can consume any cost savings that a hospital or medical practice would have recognized.
“For the physicians that are involved in an accountable care organization or a gain sharing agreement, there’s a direct financial link to their own reimbursement that really incents them to do the right thing when it comes to medication management.”