“Why can they not take their pills as I told them to?”
“Why do they always prescribe pill after pill? We have to buy groceries, too!”
Doctors grumble that patients do not follow their instructions. Patients grumble about the number of pills they have to take, and their costs.
The result: Nearly half the patients who have high blood pressure continue to have poor control.
Just the facts, ma’am!
There are about 7 billion people in this world.
Nearly a billion of them have high blood pressure, also called hypertension. Not all of them are even aware of their condition, because hypertension quite often does not cause any symptoms early on, thus meriting its name, “The Silent Killer.”
Of the millions of patients who see their doctors for blood pressure, only half experience decent control.
The USA
Every third American adult 20 years or older has hypertension.
Almost two out of three Americans 60 years or older have hypertension.
Three out of ten adults 80 years or older are taking 3 or more different classes of blood pressure medications.
Billions spent!
The estimated direct and indirect cost to the US for hypertension was $46.4 billion in 2011. The result: only 50% control!
Why to worry?
Worldwide, high blood pressure is the top-ranked avoidable cause of premature death.
Poor control of this common condition will set you up for heart attacks, heart failure, kidney failure, strokes … and the list goes on.
If this does not stir us into action, what will?
How to fix it?
You can’t fix it until you find out what is the reason for this mess.
Incorrect BP measurement
This is a big problem. We need to standardize how blood pressure is checked. Please refer to our earlier post where this is discussed in detail: http://goo.gl/pSIJSz.
Pills and the man
For a medication to work, the prescription must be written: for the right drug, and in the right dose. It must then be filled by the patient, who should take it as prescribed.
As they say, however, there is many a slip between the cup and the lip.
How many pills?
Nearly 70% of Americans are on at least one prescription medicine.
More than half receive 2 prescriptions. Thirty two million people take 3 or medications daily in the US.
How about 5 or more prescription drugs? Twenty percent of Americans take that many.
Americans aged 65-69 take nearly 14 prescriptions yearly, with the number going up to 18 in people aged 80-84 years.
The total spending on prescription drugs was $250 billion in 2009, about 12% of the total money an average American spent for his or her health care.
The failure to take medications correctly, for whatever reason, increases medical costs by up to $290 billion a year.
Take your pills? Yeah, right!
The more the number of pills you are supposed to take every day, the less likely you are to take them.
A study published in the Journal of Managed Care Pharmacy in 2012 showed that patients with chronic diseases are more likely to take once a day medications correctly than medicines which are to be taken several times a day.
Patients take once a day medications correctly 80% of the time, on an average. This drops to almost 50% when dealing with medications requiring four times a day dosing.
Fixed dose combinations
If patients are prescribed two different medicines for high blood pressure, less than 70% of them take their pills as prescribed. If they are prescribed a fixed dose combination of the same drugs in the form of one pill, the compliance rate goes up to almost 80%.
Write/Right prescription?
Inadequacies of the healthcare system also contribute to poor blood pressure control.
Many patients lack easy access to health care. Some do not have proper continuity of care, going from emergency room to emergency room, or clinic to clinic. It is difficult for them to be on a well-designed care plan, and often their medicines keep getting chopped and changed. Not surprisingly, many of them have uncontrolled blood pressure.
For some patients admitted to a hospital, the discharge planning process is inadequate, leaving the patient confused about which medications to take and for how long.
Fill the prescription!
According to one study, new medications for high blood pressure were not filled by patients 20-22% of the time. A pill existing only on a prescription pad will not bring your blood pressure down!
But it is not always the patient’s fault.
Food or medicines?
Drug costs keep going up.
Even among patients with some kind of drug insurance, there is the issue of co-pays. The more medicines you are on, the more is the pain of co-pays.
Insurance companies and employer groups have found that if they reduce or eliminate co-pays, patient compliance with medications improves.
Doc, I forgot!
It is difficult to remember to take medications day after day.
Then there are patients who have issues with declining memory.
Fortunately, there are aids available, such as boxes with labeled compartments, and also phones with reminder alarms.
Side-effects
This is a fairly common reason for a patient to stop taking his or her medications. If your high blood pressure does not cause any symptoms, but the pill your doctor gives you for it makes you feel bad, you won’t take it for long.
Conclusions
- If a patient does not take medications correctly, it is usually symptomatic of wider, deep-rooted issues.
- We need to focus more on patient education.
- The healthcare system has to address issues of access and affordability.
- Drug companies must come up with better and wider patient-assistance programs.
- We need to simplify the drug regimes of the vast majority of patients.
Want to read more?
High blood pressure is a major threat to humanity worldwide.
Current levels of blood pressure control are unacceptable.
The multiple factors complicating blood pressure control are discussed in more detail in my book, “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control,” available at http://goo.gl/t3h2zs.
People just don’t understand how important it is to get their prescriptions filled and take them!! It seems they would rather pay their cell phone bill than buy their medications. Unfortunately this will cost them more in the long run. Great information.
Thanks, Emily!
I had a chance to visit health care providers many times in past few months and I can say with certainty that majority , if not all , of the providers did not check the BP the way they should . Being in health care myself I can say with certainty that it’s a vital sign most of the people disregard as it does not lead to any symptoms until it’s too late !!! Hope people will get more aware of it after reading your book.
thanks for your comments. All of us need to get more involved in the battle against this terrible disease.