No solution in sight
Reports of long-standing problems often include talk about solutions. At least that is what we have come to expect from reasonable people. So what is going on with a national problem that has been going on for decades, has received a fair amount of press, but has rarely seen practical suggestions for solutions?
That problem is commonly referred to as medication compliance. It includes a host of issues such as inaccurately taking prescribed medications, not filling prescriptions and deliberately cutting doses to save money, all of which have potentially dire, if not deadly, consequences.
I have seen this problem on an almost daily basis in my 37 years as a nurse. Medical professionals lament the problem but hardly anyone has done much to try to improve the situation. Pharmacists, nurses and doctors try to do their best but most just throw up their arms and hope for the best because they believe the root causes are beyond their control.
In a July 21 Reuters story on Medscape.com it was noted that, "More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them at hospital discharge."
They went on to point out that, "Overall, 20% to 30% of prescriptions are never filled, and 50% are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention ."I think this says that we need to do a better job of understanding a patient at the time of discharge, what are their risks of having a post discharge adverse event...In healthcare, "there's a lot of moving parts and it's difficult to make sure they all move in tandem," Dr. Benjamin Brooke noted. "A patient may see a doctor for 20 years and then end up seeing another one who does not know their medical history as well. But this is a global issue. There's a lot of errors that occur when we leave the hospital."
What might be characterized as the understatement of the century from Brooke, "The main thing is, we need to be aware of the problem and the study points out some of the things we need to focus on more closely."
Unless Brooke is just out of school or has been living under a rock during his medical practice days, his statement points out how difficult it will be to solve this problem. Awareness of medication compliance issues has been with us for decades. Studies have been done to point out the problem but few of these studies or papers offer any solid suggestions to solve the problem.
We need to start seeing more papers that describe studies to improve medication compliance. I have read a number of such papers and there have been efforts made to craft solutions, but they do not offer solutions for enough people.
The best way to make sure someone is taking their pills is to have a second person give them out. That could be a nurse or family member or friend. It is labor intensive and often costly, especially when done in an institutional setting, so it is not a solution that works for a lot of people.
Since medication compliance is such a large and costly problem one way to chip away at it and save a lot of money would be to change the rules for home health care services and allow nurses to get paid to see patients solely to help with medication compliance. Vermont Medicaid does provide for that service but Medicare does not.
There a lots of devices on the market to help people to take their pills accurately and some work well for some people. For my money, the best of these is the bubble pack that can be created by local pharmacies. It requires a lot of work on their part and they should be reimbursed for the extra work. It is a system where they put every pill in a sealed bubble and mark that bubble for the day and time pills are to be taken.
Perhaps we need to take a closer look at the medication delivery systems we use and push for a new technology that is more sophisticated than pills, injectables and medications that are delivered topically, transdermally and by suppositories.
The high cost of prescription drugs is another big issue causing poor compliance and it is an issue that few in this country are willing to tackle. Imagine what it is like knowing there is a medication that could save or prolong your life but you cannot afford it. It should be a criminal offense to put such a drug out of reach.
We need to develop a more collective approach to the problems related to medication compliance. The problem has been identified but there have not been enough practical solutions implemented. The time has come for more meaningful action.
Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at firstname.lastname@example.org.
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