The process should be easy enough.
You visit your doctor for an examination and are prescribed a drug to address your particular medical problem. Your pharmacist fills that prescription and you're well on your way to recovery.
But according to a new study released by the Canadian Association for Retired Persons (CARP) and Shoppers Drug Mart entitled “Pharmacist Interventions in Medication Adherence,” 50 per cent of Canadians with chronic diseases are non-adherent to their medications. The study goes on to say that one in three prescriptions go unfilled or, even if they are filled, are not taken.
The reasons vary, said Omar Alasaly, a pharmacist who has been working in Victoria for eight years.
“Sometimes people's symptoms disappear and they stop taking the medicine too early, or sometimes they just can't afford the medicine,” said Alasaly. “Sometimes they just forget to take the pills.”
The instructions that accompany prescribed drugs can also be problematic if not followed exactly.
For example, taking a pill with food or after a meal can ensure that the medication is effective and doesn't cause harm, yet this instruction is frequently ignored.
Stopping medication without a doctor's advice or taking pills only intermittently can also have serious consequences.
The report indicates people need to be more diligent, not only for their own sake, but for society as a whole. Nation-wide, 69 per cent of medication-related hospitalizations are due to non-adherence to prescription protocols. Those hospitalizations increase the cost of health care by an estimated $7 to $9 billion annually.
“This is why it's so important that pharmacists build relationships with their clients and engage in one-on-one consultations. The health care system is under enough pressure without adding preventable costs arising from people not taking their medications or taking the wrong medications in the wrong way,” added Asalay.
He said his consultations with clients often highlights problems which prompt him to contact the client's doctor with a request medications be reviewed, particularly when clients have visited more than one doctor and received multiple prescriptions.
The situation is of particular concern for an aging population. A national survey conducted by CARP reported that 53 per cent of CARP members are taking four or more prescription medications at any given time. It's not uncommon for seniors to be juggling a dozen different drugs simultaneously.
Since older Canadians are more likely to deal with adherence issues, the report suggests that pharmacists help to simplify the process through the use of compliance packs; cards or containers that organize medications in weekly (or daily) packaging that helps to ensure that the correct medications are taken at the correct time of day and in the correct way.
But according to Alan Cassals, adjunct professor and policy researcher at the University of Victoria, the problem may have deeper roots than prescription adherence which involve the over-prescription of drugs in the first place, particularly to seniors.
“Older people see lots of doctors and specialists and are frequently prescribed drugs that have no life-saving or substantial quality-of-life benefits,” said Cassels. He added that a part of the approach for dealing with individuals taking their medications in an inappropriate manner should be to reduce the number of medications being prescribed.
“Doctors have to do a much better job of consulting with patients to ensure that there is a rational and necessary reason for every prescribed drug,” said Cassels. “It's much harder for a doctor to talk a patient out of a drug than it is to issue a prescription and get them out the door, but that approach sometimes results in a massive and unnecessary number of prescriptions.”
Cassels agreed that pharmacists can and must play a role in preventing the overuse of prescription drugs.
“They're the ones that see the prescriptions coming in from a variety of doctors and can help to stem the use of unnecessary drugs or those with questionable health benefits,” said Cassels.
He added the role of pharmacists can be problematic. Since pharmacists work for pharmacies whose business model depends on selling drugs, it's not often in their company's best interest to try to encourage customers to consult their doctor in an effort to cancel a prescription.
He emphasized there are some excellent pharmacists who take patient welfare very seriously, but adds it's often not easy to do the right thing.
Asalay agreed, but maintains pharmacists must look at the long-term; building relationships and earning the trust of their clients and the community.
“Health care is expensive and prescriptions need to be appropriate and taken in a responsible manner. We all have a role to play,” said Asalay.