With an increase in lifespan and the prevalence of chronic disease, the number of new medications also continues to rise. However, recent advancements in alternative treatments and a better understanding of how lifestyle factors such as diet and exercise affect our health may cause many individuals to feel a general reluctance toward taking prescription drugs, especially on a long-term basis. Typically, effective treatment for chronic GI illnesses includes a combination of medication, a special diet or exercise routine, and ongoing monitoring. It’s important to understand that even though prescription medicines usually come with certain risks, a physician only prescribes them after weighing those risks against the potential benefits to the patient. If ‘an apple a day’ alone could keep your condition at bay, then that is what your physician would gladly recommend.

Whatever treatment plan your healthcare team establishes for you, it can only be effective if you follow it. Research shows that 30-50% of patients do not comply with prescribed medication instructions, resulting in increased rates of disease-related sickness and death, as well as an increased financial burden on the healthcare system.1 “Adherence is the fundamental link,” experts say, “between intent and outcome of medical care.” In addition to taking prescribed medications consistently, at the correct time and dosage, adherence can also include attendance to follow-up appointments, submitting to certain procedures, and adopting recommended diet and lifestyle changes.


Patient Involvement & Personal Beliefs Play an Important Role

A new study, published in Patient Preference and Adherence1, analyzed eleven recent studies that focussed on the effectiveness of a number of medication reminder mechanisms, such as phone calls, emails, text messages, and others. The results of this study, as well as another very recent study2 that looked just at electronic reminder mechanisms, showed that reminders do improve patients’ adherence to medical therapy and that there is little difference in level of effectiveness among the various types of reminders.

Perhaps more importantly, however, this study’s authors say that an individual’s adherence to a treatment regimen is strongly linked to his or her personal beliefs and specific circumstances, rather than simply remembering or forgetting to take a medication. Individuals fail to follow medication regimens for a number of intentional and unintentional reasons, such as concerns about the efficacy of the prescribed treatment, fear of negative side effects, inconvenient treatment methods, poor communication and trust between physician and patient, lack of social support, poor motivation, and misinformation about how to use the medication.

Researchers recommend that medical professionals communicate in a way that acknowledges their patients’ roles in the treatment decision-making process, making themselves aware of patients’ personal beliefs and paying attention to any particular circumstances that could lead them not to follow medication instructions. Strategies might include patient education, simplified medication regimens, and ensuring convenient access to prescriptions and other medical care. Patients can be part of this process by maintaining a trusting, mutually respectful relationship with medical professionals and caregivers.

Express clearly with your physician any concerns you have that might affect your decision to stick to a medication regimen. For example, if you are worried about a certain side-effect of a new medication, possibly based on something you read on an internet site or other source, then describe this to your physician so that she or he can discuss exactly why this particular treatment is right for you. It is also a good idea to explain your treatment plan with your family or other members of your support circle.


The Case of Steve Jobs

Steve Jobs, the famous co-founder and CEO of Apple Inc., died in 2011 from cancer. Though the media often simply referred to it as pancreatic cancer, an uncommon and normally fatal form of cancer, Jobs actually had neuroendocrine cancer, a very rare form of cancer that can occur in various areas of the body. If physicians discover neuroendocrine tumours before the cancer has spread (metastasized) to other areas of the body more difficult to treat, surgery can often provide a cure. Physicians first diagnosed Jobs with the disease in 2003, when a routine abdominal scan revealed a tumour in his pancreas.3 Relieved that he had a potentially curable form of cancer, his medical team recommended immediate surgery to remove the tumour, but Jobs refused this treatment for a full nine months, preferring instead to try diet modifications not based on medical evidence. It is impossible to know what difference that nine-month delay might have made, but Jobs’ cancer did, at some point, spread to other areas, including his liver, and he died of complications directly related to the cancer.4


Economic Barriers to Adherence

A large Canadian survey that included 10,898 respondents from all ten provinces indicates that 9.6% of Canadians are not complying with their prescribed medicine regimens due to financial barriers.5 Non-adherence factors in the survey included not filling a prescribed medication, not refilling a prescribed medication, or trying to stretch out a prescribed medication by taking lower or less frequent doses than what was laid out by the prescribing physician.

The highest cost-related noncompliance was among those who reported lower household income, poor health, chronic illness, and lack of prescription drug coverage. Respondents who did not have insurance coverage for prescription drugs were four times more likely to report cost-related noncompliance than those who did have coverage. Those who had two or more chronic conditions were 1.61 times more likely to report cost-related noncompliance than those who had no chronic conditions.

The researchers were surprised to find the highest rate of not adhering to prescribed medicine regimens due to cost was in British Columbia (the lowest was in Quebec). They suggest that BC’s higher deductible rates for the public drug plan and higher levels of debt among BC residents may be important factors. The authors suggest that policy changes around public insurance coverage may be the key to lessening the burden of out-of-pocket expenses for prescription drugs in Canada, which would increase patient adherence, improve Canadians’ health, and decrease hospital admissions for acute health problems.


New Tools

Knowledge is the Best Medicine (KiBM) is a program funded by Canada’s Research-Based Pharmaceutical Companies that offers free tools to help patients keep track of their medical history and follow the treatment regimen their physicians have prescribed. KiBM is intended to help patients work better with their entire healthcare team, including physicians, pharmacists, and other medical professionals involved in their care, by using a KiBM tool to keep an up-to-date medication list with them at all times.

The most recent tool KiBM is rolling out is a new iPhone app – MyMedRec – that allows patients to easily track and schedule their medicine intake and other treatments. Patients can share the records accumulated using MyMedRec with family, physicians, and other members of their healthcare team, when appropriate. The tool also can send reminders to patients when it’s time to take a dose of medicine and refill prescriptions.

For more information about the MyMedRec app, helpful tips on keeping on top of your treatment regimen, and personalized forms and booklets you can download and print, visit www.knowledgeisthebestmedicine.org.

First published in the Inside Tract® newsletter issue 182 – 2012
1. Fenerty SD et al. The effect of reminder systems on patients’ adherence to treatment. Patient Preference and Adherence. 2012;6:127-35.
2. Vervloet M et al. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. Journal of the American Medical Association. April 25 2012 Available at http://jamia.bmj.com.ezproxy.library.ubc.ca/content/early/2012/04/12/amiajnl-2011-000748.long. Accessed 2012-07-09.
3. Elkind P. The Trouble with Steve Jobs. CNNMoney.com. 2008-03-05. Accessed 2012-02-24.
4. Wikipedia. Steve Jobs page. Available at http://en.wikipedia.org/wiki/Steve_Jobs. Accessed 2012-02-29.
5. Law MR et al. The effect of cost on adherence to prescription medications in Canada. CMAJ. 2012;184(3):297-302.