Addressing woes in treatment compliance

For people with chronic or longstanding diseases which require prolonged treatment, medications are often as much as part of the daily routine as brushing their teeth. In treating diseases such as heart failure, the drug regimen may require complicated pill schedules that could confound even the most diligent and organized individuals. However, even if it requires only taking a single pill, compliance can still be a problem for many.

What many patients do not realize is that what appears as a simple medical problem such as an elevated cholesterol level, which would have required a simple drug regimen, may result in serious complications such as heart attacks and strokes if left untreated or inadequately treated because of poor compliance. The complicated state would require more pills to take which would further worsen the compliance problem.

Many physicians struggle with issues of medication adherence in their daily practice. Compliance experts advice that doctors should try to prescribe their patient with drug regimens that would suit their lifestyles and budget. Although the burden of compliance is really on the patient, the physician should make sure that important compliance issues are properly addressed so that the patients stick to a drug plan to maintain good health.

There are some studies which point to a specific personality profile that could predict patients with poor compliance. Patients who are more organized, high-strung, with very structured lives, and serious at work are supposed to show better compliance. However, this profile does not hold true in Third World countries where cost of medications is still a major predictor of compliance and the patient’s personality profile is just a minor factor.

Since cost of medications is a major issue in the patient’s adherence to the prescribed drug regimen, the big challenge to the big pharmaceutical companies in the country is to come up with high-quality but reasonably priced medicines which the average Filipino worker can afford. This is especially true for drugs needed to threat cardiovascular diseases which are now the leading causes of deaths among Filipinos.

Cholesterol-lowering drugs such as statins have now been shown to significantly reduce the incidence of heart attacks and strokes even in patients with just average cholesterol levels. Giving statins, especially to high-risk patients such as diabetics and those with multiple risk factors, may help reduce cardiovascular complications and prolong life. However, statins, because of their cost, have been saddled with compliance problems.

Simvastatin is one of the most scientifically documented statins; its efficacy and clinical benefits have been proven by large-scale, well-designed clinical trials. A big boost to compliance of local patients is the introduction of an affordable brand of simvastatin by Therapharma. It is hoped that other companies will follow suit in bringing down the prices of their essential drugs for various cardiovascular ailments such as hypertension and elevated cholesterol levels.

Health experts have identified common barriers to compliance which physicians should be aware of:

• One barrier is the dose frequency or the number of times that pills must be taken each day. Patients who are required to take pills thrice a day, may have serious compliance problems. Usually, the middle dose is missed.

• Pill burden, or the number of pills that have to be taken each time, can also be daunting for some patients. The more pills patients have to take each time, the poorer is the expected compliance.

• Sometimes just the reminder of being sick is a burden that can prevent good compliance. Even patients who must take only one pill a day will sometimes say, "It reminds me of my illness every time," and that becomes a barrier for them.

• Then there are the lifestyle-related issues such as "I work, and when I get home, I’m really tired. I don’t remember," or "I remember my pills every night before I go to bed, but in the morning I have so many things to do I cannot remember," or "I get my kids out of bed and I give them their medicine, but I forget mine."

• The incidence of side-effects is also a major issue. If a patient experiences or thinks he or she experiences a side-effect with a medication, it impairs drug adherence.

• Lastly, but probably the most important factor in developing countries like the Philippines, is the cost of medications. Ideally, the doctors should be familiar with the actual price of the drugs he prescribes. It would be futile to make a prescription which the patient would not be able to buy anyway.