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Sample Medication Compliance Study:
Treatment Adherence With Lithium and Anticonvulsant Medications Among Patients With Bipolar Disorder
Martha Sajatovic, M.D., Marcia Valenstein, M.D., M.S., Frederick Blow, Ph.D., Dara Ganoczy, M.P.H. and Rosalinda Ignacio, M.S.
Nonadherence limits the effectiveness of medications among patients with bipolar disorder. This study examined adherence with lithium and anticonvulsant medication among patients with bipolar disorder receiving treatment in Department of Veterans Affairs (VA) settings.
Patients receiving treatment in the VA for bipolar disorder during federal fiscal year 2003 (FY03) and receiving lithium or anticonvulsant medication were identified (N=44,637) by using the VA's National Psychosis Registry. Medication adherence was assessed by using the medication possession ratio (MPR) for lithium, valproate or divalproex, carbamazepine, and lamotrigine. Patients were categorized into three groups: fully adherent (MPR greater than .80), partially adherent (MPR from more than .50 to .80), and nonadherent (MPR less than or equal to .50). RESULTS: A slight majority of individuals (54.1%) were fully adherent, 24.5% were partially adherent, and 21.4% were nonadherent. Nonadherent individuals were more likely to be younger, unmarried, nonwhite, or homeless or to have diagnoses of a substance use disorder or fewer outpatient psychiatric visits in FY03. Adherence intensity was somewhat lower for valproate, compared with lithium or other anticonvulsants. Individuals given prescriptions for two agents to stabilize mood had better adherence than individuals given prescriptions for a single agent. Unexpectedly, in multivariate analyses adjusting for prior hospitalization, number of outpatient psychiatric visits, and a diagnosis of substance use disorder, poorer adherence was associated with decreased rates of hospitalization.
Nearly one in two individuals given prescriptions for lithium or anticonvulsant medication to treat bipolar disorder did not take their medications as prescribed. The effectiveness of bipolar medication treatments is reduced by high rates of nonadherence in clinical settings.
Did you know that 10% of all hospital admissions and almost 30% of admissions to nursing homes are due to improperly taken prescription medications?
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Patient Compliance: Patients may be noncompliant for many reasons. The most obvious cause is simple forgetfulness, a more likely circumstance if a medication is being used for an asymptomatic condition such as hypertension. Learn more
Keeping Up with Medication Dosage and Frequency is Vital to Your Health ...
.... The patient had been diagnosed with hyperlipidemia, or high cholesterol. The doctor prescribed a statin, a lipid lowering drug. After taking the drug for a while, the patient's cholesterol level came down. He stopped taking his medication.
The patient later began to experience shortness of breath when exercising and some pressure in his chest. Subsequently, he experienced chest pain and had to have open-heart surgery......
.... This patient was former President Bill Clinton.
President Clinton was fortunate. Other patients who stop taking their cholesterol medication, or do not adhere to their prescribed dosages, are not so lucky. In fact, approximately 125,000 deaths in the United States each year are attributed to noncompliance with a doctor's prescription, twice the number of people killed in automobile accidents.
Medication Compliance / Patient Adherence is the practice of taking your medication as your physician prescribed it.
50% of people presently on medication do not take it as prescribed
To be Non-Adherent means you have, for some reason, deviated from the course the doctor prescribed. Perhaps you take your medicine only occasionally, perhaps you never filled your last prescription; perhaps you never took it at all.
Do not be surprised if this describes you. In fact,
This is a serious problem in today's world because medication non-adherence causes health complications (subsequent ailments, more doctor visits, lost work, trips to the hospital, etc.) that ripple out across our health care system costing approximately $177 billion a year in addition to the immeasurable amount of pain and loss of life.
C. Everett Koop, the former U.S. Surgeon General: "Drugs don't work if people don't take them."
The most common types of noncompliance include:
Not having a prescription filled
Taking an incorrect dose - too much or too little
Taking the medication at the wrong time
Forgetting to take one or more doses
Stopping the medication too soon
According to the World Health Organization, the
noncompliance rate for long-term therapies averages 50 percent. Boston Heart Party™ results from last spring's annual enrollment health fairs suggest that GIC enrollees may not be compliant with their heart medications or are not under treatment for their cardiovascular disease risk.
More than 1,600 GIC enrollees took advantage of the free screenings. Although participants may not mirror the entire GIC population, and fasting tests provide more accurate cholesterol and glucose readings, over 50% of GIC enrollees taking the test reported having a known risk factor for heart disease and many of these same people still exhibited "at risk" screening results, which suggests that they may not be following doctors recommendations (the GIC received only aggregate data).
High Blood Pressure (Hypertension):
High blood pressure, or hypertension, is very common, affecting over 18 million workers in the United States. According to the National Health Information Survey, 35% of those with hypertension have not been diagnosed. Known as "the silent killer", high blood pressure is a condition in which the pressure of the blood in the arteries is too high. The normal range is 120/80 mm Hg (millimeters of mercury). If your pressure is consistently above this range, you have high blood pressure and are at risk of a heart attack, stroke and kidney disease. The top (systolic) number measures the pressure when the heart beats. The bottom (diastolic) number is the pressure when the heart is at rest.
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines high blood pressure for non-diabetics as 140/90 or more. Of the GIC enrollees screened at the fairs, 26% of women and 44% of men had high blood pressure readings. Prehypertensive (at risk for high blood pressure) means the systolic number is between 120-139 or the diastolic is between 80-89. Of the GIC enrollees screened, 60% of women and 68% of men had prehypertensive blood pressure readings.
High Cholesterol (Hyperlipidemia):
Over 37 million American workers have hyperlipidemia. Like high blood pressure, many Americans are unaware that they have high cholesterol. Forty-one percent of those with hyperlipidemia have not been diagnosed. Cholesterol travels in the bloodstream in the form of various-sized particles known as lipoproteins. Elevated cholesterol means that you have more cholesterol in your blood than your body needs. Total cholesterol levels should be under 200 milligrams per deciliter (mg/DL), according to the National Institute of Health. Fifty-two percent of GIC women screened had total cholesterol levels greater than 200, including 17% with levels above 240. Forty-four percent of GIC men had total cholesterol levels greater than 200, including 13% with levels above 240.
High Blood Sugar (glucose):
Four percent of the workforce has diabetes, which is indicated by high blood sugar levels greater than 126 (mg/DL). Forty-one percent of workers with diabetes are undiagnosed. Levels of glucose rise in the blood because the glucose is not getting into the body's cells. Diabetes more than doubles your risk for a stroke or heart disease. Although fasting is necessary to get the most accurate glucose readings, levels greater than 199, with or without fasting, indicate a need to seek treatment immediately. Fifteen percent of GIC women and 21% of GIC men had glucose levels greater than 126. One percent of GIC women and 3% of GIC men had readings greater than 199.
So why do patients not follow their prescribed drug regimen for lowering risk for heart disease? A 1999 study published in the Journal of the American Geriatrics Society identified 26 factors that lead to noncompliance. Compliance decreased as the complexity, cost and duration of the medication regimen increased. Patient-related factors that contribute to noncompliance include lack of social support, an unstable living environment, mental illness, limited financial resources, denial of the illness, and low perceived susceptibility to the disease.
The busiest patients were found to have the lowest rate of compliance. Poor communication between the patient and his/her provider also led to noncompliance.
Patients must take their medication as prescribed in order for the medication to be effective. Failure to do so can cause side effects that may be mild -- or potentially fatal. The American Heart Association recommends the following tips for remembering to take medication as prescribed:
Take it at the same time every day; take it along with meals or other routine daily events
Use special pill boxes, such as the one divided into sections that can be found at most drug stores
Keep a medicine calendar, or use a white board or sticker system to record your medications
Work with your doctor to develop other tools to help you keep up with your drug regimen.
NEVER stop taking your medication without first talking to your doctor.
32 million Americans use three or more medicines daily
75% of adults are non-adherent in one or more ways
The economic impact of non-adherence is estimated to cost $100 billion annually
The average adherence rate (the degree to which patients correctly follow prescription instructions) for medicines taken only once daily is nearly 80 percent, compared to about 50 percent for treatments that must be taken 4 times a day. As many as 75 percent of patients (and 50 percent of chronically ill patients) fail to adhere to, or comply with physician prescribed treatment regimens.
In a recent poll of U.S. individuals 65 years old and older who use medications, researches found that 51% take at least five different prescription drugs regularly, and one in four take between 10 and 19 pills each day. 57% of those polled admit that they forget to take their medications. Among those using five or more medications, 63% say they forget doses, compared to 51% among those who take fewer medicines. (10)
Drugs don't work in patients who don't take them
C. Everett Koop, MD
Remembering to take your medicine is the key to compliance. Medicine will be effective only when taken as prescribed by your physician. Professional Info
Get Medsmart: Despite the fact that medications can save or extend lives, the average patient fails to follow her/his pill prescription half the time.
The reasons behind this failure are varied; ranging from simple forgetfulness to confusion to ambivalence, but the problem costs an estimated $290 billion in emergency-room visits and other avoidable medical expenses in the United States (11).
Studies have shown than non-compliance causes 125,000 deaths annually in the US (2), leads to 10 to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. It is, in the words of The New York Times (1) the world’s "other drug problem".
Negative Economic Effects of Non-Compliance
· 23% of nursing home admissions due to noncompliance(3).
Cost $31.3 billion / 380,000 patients.
· 10% of hospital admissions due to noncompliance (4,5). Cost $15.2 billion / 3.5 million patients.
· About 50% of the 2 billion prescriptions filled each year are not taken correctly (7).
· 1/3 of patients take all their medicine, 1/3 take some, 1/3 don't take any at all (Rx prescription never filled) (6).
· 25,000,000 nonprofessional caregivers in the US (8).
· 80% of nonprofessional caregivers are women (8).
· 80%-90% of people requiring care in the US receive it from family members or friends (9).
1. The New York Times June 2, 1998
2. Smith, D., Compliance Packaging: A Patient Education Tool, American
Pharmacy, Vol. NS29, No 2 February 1989
3. Standberg, L.R., Drugs as a Reason for Nursing Home Admissions, American Health care Association Journal, 10,20 (1984).
4. Schering Report IX The Forgetful Patient: The High Cost of Improper Patient Compliance.
5. Oregon Department of Human Resources, A study of Long-Term Care in Oregon with Emphasis on the Elderly March 1981.
6. Hayes, R.B.NCPIE Prescription Month, October 1989
7. National Council for Patient Information and Education.
8. Rosalynn Carter Institute of Georgia Southwestern College.
9. Parade Magazine, 1/29/95.
10. Med Ad News February 2010
11. New England Healthcare Institute
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... Perfect health and compliant patients! ... A wonderful dream, but unreal for most of us. | Medication Adherence for the Practice of Pharmacy | Features e-pill Automatic Dispensers | e-pill Videos
Non-Adherence is the major controllable cause of preventable rehospitalizations.
In a poll of U.S. individuals 65 years old and older who use medications, researchers found that 51% take at least five different prescription drugs regularly, and one in four take between 10 and 19 pills each day. 57% of those polled admit that they forget to take their medications. Among those using five or more medications, 63% say they forget doses, compared to 51% among those who take fewer medicines. | Home Page | Clinical Studies | Proportion of Days Covered Definition | Pill Dispenser Pharmacy Filling Program | Link Productivity / Medication Adherence | Published Data | CAGE Questionnaire.
Drugs don’t work in patients who don’t take them
C. Everett Koop, MD
Failure to comply with medication regimens is a major health care problem.
1.6 billion prescriptions are written every year in the United States.
Source: National Council for Patient Information and Education, Washington, DC. Compliance Statistics
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With up to 12 Daily ALARMS, Medical Snooze and a Medical ALERT ID databank, the e-pill CADEX Medication Reminder Alarm Wrist Watch (7 designs - see below) takes the worry out of taking medications, so you can spend your time enjoying the more important things in life. Features the e-pill Medical Snooze function.
Choose the right CADEX / CADEX Accessory for you or your patient:
Suggested retail price $139.95 On SALE now | U.S. Patent 6,560,165
CADEX®, ePill® and e-pill® are registered trademarks. Visit CADEX Web site. Scroll down below to see all CADEX Alarm Watches and CADEX Alarm Timers:
The CADEX Medication Reminder takes the worry out of taking daily medications, so you can spend your time enjoying the more important things in life.
Never Forget to take your Medications Again! Feel Better. Avoid Medication Errors
TIMER WATCH: The CADEX wristwatch has up to twelve (12) daily alarms (medication reminders). The alarms auto repeat every day, no reset required. At the scheduled time (same time every day), the alarm will sound and display the name of the medication to be taken.
This e-pill nags you! A unique Medical Snooze feature allows you to turn off the initial beeping and continue to be reminded with a subtle double beep every three (3) minutes until you have taken your all your medications (for up to 4 hours).
MEDICAL ALERT: In addition to being a great medication reminder the Emergency ALERT Data Bank stores your critical health information, similar to a Medical Alert I.D. Bracelet. Pressing the ALERT button on the alarm watch will display the following MEDICAL ALERT Information: | How to ERASE Information
Water and shock resistant (do not wear in shower or swimming pool)
Used in Clinical Trials
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When you purchase a CADEX alarm watch we recommend that you program the watch and make sure you like the style and ease of use. If you do not, return it promptly in its original packaging for a complete refund.
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The e-pill CADEX watch comes with a One (1) year warranty guaranteeing its inner components. This does not cover the band, buckle, battery, case, buttons or crystal. During the warranty period and upon proof of purchase, the watch will be repaired or replaced free of charge (please contact your dealer). If you purchased your CADEX watch directly from the manufacturer (e-pill, LLC), please call us toll free at 1-888-726-8805 (+1 781-239-8255). We look forward to assisting you
e-pill Medication Reminders is Boston based medical device company. Since 1999 e-pill timers, alarm watches, pill boxes with alarms and pill dispensers have helped patients around the world remember to take medications on time (improve medication adherence / patient compliance).