Forgetting to take medication

The treatment of some illnesses commonly includes the long-term use of medications. Although these medications are effective in combating these diseases, their full benefits are often not realised because many patients do not take their medications as prescribed.  Sade Oguntola writes on ideas to take medications as scheduled.

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.

People do not realise the real damage or consequences of non-adherence. When patients with chronic conditions such as hypertension and diabetes do not take medication as directed, the repercussions can be severe.

Unfortunately, many people do not take their medication according to the doctor’s advice. Either they forget to take it, or take it in the wrong dosage. Either way, it doesn’t help.

The challenge is more with elderly people, who often have to take many medications for different conditions and they either forget their medication or take it at the wrong time. Moreover, there are those who discontinue the medication if they feel better.

In the case of antibiotics, for example, this is counter-productive. Stopping midway may not be sufficient to effectively deal with the underlying infection which might recur. Worse still, the infection could become resistant to that particular antibiotic and might necessitate a change.

Mrs Helen Oduntan, Director, Pharmaceutical Services at University College Hospital, Ibadan said although these medications are effective in combating diseases, their full benefits are often not realised because many  individuals do not take their medications as prescribed.

Directions for medications, supplements and vitamins exist for a reason. Some medications are absorbed better if taken before meals, while others might be indigestible if taken on an empty stomach. Some must be taken for a fixed number of days to be sure that the disease does not relapse.

Also, withdrawal symptoms can occur with some medications. Taking some medicines later in the day can disrupt sleep cycle, interfere with digestion or impact energy level.

Howbeit, with many medications there are also no immediate consequences. So individuals might not realize they had missed a dose. It may take a few days or weeks to notice a big difference.

Factors contributing to poor medication adherence are myriad; they are interplay of a range of factors including patient views and attributes, illness characteristics, social contexts, access and service issues.

According to Mrs Oduntan, “some may forget; some may not be convinced of the medication’s effectiveness or be unsure that it is working and others may dread the side effects or have difficulty taking the medication, particularly injections or inhalers. For some, the rising cost of prescription medications is a barrier.”

In a study, experts found that 77 per cent of patients demonstrated high degrees of compliance with their medication regimen when the treatment was designed to cure a disease and only 63 per cent of patients complied when treatment was aimed at prevention. However, when medication was to be taken over a long period, compliance rates dropped dramatically to around 50 per cent for either prevention or cure.

The consequence of non adherence is waste of medication, disease progression, reduced functional abilities, and a lower quality of life, increased use of medical resources such as nursing homes, hospital visits and hospital admissions.

Medication adherence is defined by the World Health Organisation as “the degree to which the person’s behaviour corresponds with the agreed recommendations from a health care provider.”

Simple strategies for taking medication

Health care professionals such as physicians, pharmacists and nurses have significant role in their daily practice to improve patient medication adherence.

According to Oduntan, medication-taking strategies need to be discussed with the individual by a pharmacist. Identifying specific barriers for each patient and adopting suitable techniques to overcome them will be necessary to improve medication adherence because what is helpful for one person may not be for another.

Also, she suggested buying medications from registered pharmacy shops where they will also get professional counsel on their appropriate use, how to prevent an adverse drug reaction, if possible, and also convincing the patient of the need for treatment.

“In some instance, if there are unpleasant side effects, they can easily ask for a change of medication. That a person experiences a low libido is not a reason to stop a medication, since it would be changed to another one.”

Reading leaflets in medication packages, she said is also important. Such leaflets inform on things that patient should necessarily know, including its possible side effects.

Incorporating the medication regimen into daily routine is also as important as keeping to one hospital to maintain health records to ensure access to personal medical information, especially in emergency situations.

Use of medication adherence improving aids such as medication calendars or schedules that specify the time to take medications, drug cards, medication charts or medicine related information sheets or specific packaging’s such as pill boxes, ‘unit-of-use’ packaging, and special containers indicating the time of dose as well as phone reminder alert is also helpful.

Enlisting a family member or friend can help to stay accountable. A good friend or lover, non-judgmental family member can really help to get in the habit of taking something consistently.

When travelling, Oduntan advised carrying drugs along in their original containers in a carry-on bag to ensure they can be taken as scheduled. On longer trips, an extra week’s supply of medications and copies of the prescriptions, in case there is the need to get a refill, is also necessary.

Where cost is a reason for non compliance she suggested talking with the pharmacist or doctor for another that is both effective and affordable.

Also, she emphasised the need for regular clinic attendance in case of chronic illnesses like hypertension and to avoid taking other drugs and supplements with their normal or regular drugs to prevent drug-drug interactions.

When individuals take it upon themselves to learn more about their health problems, she said adherence to medications to ensure they handle their health better will not be a challenge.