A simple way to save healthcare dollars

Can you answer this Trivial Pursuit-type question? What prolongs illness, increases the severity of disease, necessitates more intensive treatment, increases the rate of hospitalization and costs this country an extra $7 billion to $9 billion annually in medical expenses? Odds are I’ve got you on this one.

The answer is non-compliance; patients not following their doctors’ instructions, or using medication improperly. Dr. Robert Coambs, of the Centre for Health Promotion at the University of Toronto, headed a research team to study this problem.

Amazingly, 50 per cent of diabetics, 57 per cent of menopausal women, 40 per cent of hypertensive patients, 20 per cent of asthmatics and a whopping 71 per cent of arthritic patients fail to follow their doctors’ advice.

The bottom line? Half of all patients in Canada do not follow the treatment prescribed by their doctor. It’s estimated the cost of non-compliance is equivalent to the total cost of coronary heart disease, the nation’s number one killer. This makes non-compliance one of Canada’s most expensive medical burdens. stop the medication too soon or use it erratically. Still others take it with alcohol. And a stunning 33er cent never get the prescription filled at all.

One might say at this point, with such an dismal track record, there’s only one way to go — up. But unfortunately this lackadaisical trait appears to be worsening and the problem needs to be addressed.

Canadians are living longer, and with an aging population the use of prescription medicines will increase. And the more prescriptions, the more misuse of medication.

There are many causes for non-compliance. An advertisement in 1992 shows a physician observing: “When my patients don’t return, I assume the therapy is working.” But in a story on the facing page, a patient says: “I just couldn’t bear to tell my doctor his migraine therapy didn’t work.”

Some sufferers reject their doctors’ advice due to a failure to improve, or because of adverse side effects of the medicine. But the primary cause of patients not filling prescriptions in the first place is they simply don’t believe they need them.

Patients who suffer from “silent killers,” chronic conditions that have few or no symptoms, often fall prey to non-compliance. High blood pressure is a prime example. It can be present for years without any significant symptoms. The first evidence may be a massive stroke or heart attack.

As well, patients suffering from glaucoma, increased pressure in the eye, may be going blind gradually without being aware of it. Some postmenopausal women stop using the Estraderm patch or Premarin for fear that estrogen causes cancer. In doing so, some increase the risk of bone fracture, which either contributes indirectly to ending their life or forces them into a wheelchair. Others up their odds of a premature heart attack or suffer needlessly for years from painful intercourse.

What is the best way to fight non-compliance? One word: communication.

Doctors must ensure patients understand their illnesses, the reason for the prescribed medication and the instructions for its use.

But communication is easier said than done. Studies show that at any given medical visit, patients forget 31 per cent to 71 per cent of what the doctor explained.

Here are some tips to improve communication and compliance:

• Confirm you understand the doctor’s instructions; take notes.
  
• Finish the entire medication series, even if your symptoms disappear.
  
• Never take anyone else’s medication.
  
• Use a pill organizer to help you remember when to take your medication.
  
• And remember that medications and alcohol don’t mix.

It’s often said that to be successful in life, you must be the right person, in the right location, at the right time. As far as medication goes, you need the right drug for the right person, at the right time and in the right dosage.