Given but not taken: When your patients don't take their medicines

Why do patients continue to struggle with prescription drug compliance?

By Delia O'Hara, AMNews correspondent. Feb. 4, 2002.

Thirty days into the anthrax scare the country faced this fall, less than three-fourths of the roughly 10,000 people exposed to the bacteria and put on a course of antibiotics were still taking their pills.

Inhaled anthrax spores can stay in the body for long periods, and the treatment regimens recommended early in the crisis involved a 60-day course of antibiotics. Patients knew from the highly publicized outbreak that the sickness was life-threatening.

Still, at least a quarter of them stopped taking their pills. Some additional members of the cohort were "not taking them exactly as recommended," says Nancy Rosenstein, MD, an epidemiologist with the Centers for Disease Control and Prevention's National Center for Infectious Diseases.

Side effects that included nausea and diarrhea were blamed for the lack of compliance with the antibiotic regimens.

"It's a struggle to take antibiotics for this long," Dr. Rosenstein says. "For the CDC and the country in general, facing a bioterrorist event like this one, we're on a steep learning curve about how to help people through a difficult course of antibiotics."

An astonishing anecdote?

On the contrary, the anthrax experience mirrors the preponderance of evidence piled up by a series of groundbreaking studies over the past dozen years that only about 75% of prescribed drugs are taken as intended.

This experience also reflects the increasing recognition in the medical profession that the fair-to-poor complier is not just the patient with a sinus infection who stops taking his antibiotics when he begins to feel better, but also the one who knows that not taking his medicine as prescribed may result in death, blindness, incapacitation or the rejection of an organ prayed for for years. Noncompliance results in an estimated 125,000 deaths a year from cardiovascular disease alone, up to a quarter of nursing home admissions and an estimated 10% of hospital admissions. [...]