May 6, 2015

PWD Have Low Medication Adherence

I would almost say that the low adherence by people with diabetes (PWD) of medication is a diabetes complication. It certainly makes the complications of diabetes easier to develop when PWD do not take their medications.

There are several reasons that make people with diabetes not take their medications and these include:
  • The doctor goes paternalistic or maternalistic, and ignores patient questions about side effects in the medications.
  • The doctor just hands the patient a prescription(s) with no explanation or directions.
  • The doctor refuses to explain the purpose of the medication(s).
  • The doctor refuses to include the patient in the selection of the medication(s).
  • The doctor refuses to take into consideration the cost and financial implications for the patient.
  • The doctor does not check allergies.
  • The patient goes into denial.
  • The patient develops depression.
  • The patient does not understand polypharmacy and the pharmacist does not explain each medication.
A large cohort study of patients with diabetes, data on 19,962 patients with diabetes aged older than 55 years who had hypertension or dyslipidemia and had initiated treatment with a statin and ACE inhibitor. They found that 5,645 patients (28%) were nonadherent, 7,571 patients (38%) were partially adherent, and 6,746 patients (34%) were fully adherent.

The findings were very much in line with the hypotheses. The fact that only 34% of the high risk diabetic participants were adherent to medications is alarming. The fact that more than 80% adherence is associated with a 28% lower risk for major cardiovascular events compared to nonadherence is significant.

Diabetes is as much a cardiovascular disease as an endocrine one. Endocrinology will appreciate the troubling issue of polypharmacy and poor medication adherence in their patients. The physician community is interested in improving the outcomes of diabetic patients; this study drives home the need to employ innovative strategies such as emerging technologies, nonphysician care models, and polypills to get patients beyond the 80% adherence line to reduce cardiovascular risks.

Kim Eagle, MD, who is a professor of internal medicine and director of the Cardiovascular Center at the University of Michigan Health System in Ann Arbor, stated, “I am not surprised at all. Study after study show that in conditions that don't hurt every day, such as diabetes and hypertension, people think, ‘Why should I take this?' It might be cost; it might be side effects; it might be a sense of not having control over the disease.”

He said this study is very important because noncompliance is such a widespread problem in the treatment of diabetes, and it is very common for patients to say they are taking their prescribed medicines when they are not. Another problem in this area is the difficulty with documenting adherence, according to Dr. Eagle.

Dr. Eagle said, “We go over the medications every time we see them. Patients can be passive aggressive and wait until their next visit in 6 months when they have run out of medicine. “We need the whole care team, the pharmacists, extended providers and the insurance companies. It is a systems problem. Patients have different availability to caregivers and insurance.”

Some good doctors work with patients to avoid nonadherence, but many doctors are too busy to be bothered with the reasons listed above to take the time to talk with the patient. Instead they talk at the patient and just expect the patient to take the medication(s) prescribed because he/she is the doctor and knows what is best for the patient.

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