September 2000
GAINESVILLE, Fla. - University of Florida researchers have hit upon a simple way for physicians to gauge whether patients are taking their medications as prescribed: Pick up the phone and call the pharmacist.
It's a low-tech solution for an age-old problem, they said. Millions of Americans have chronic health problems that require daily treatment, but many fail to take their prescribed medications, resulting in unnecessary and sometimes life-threatening complications. What's more, their physicians may prescribe more potent or even experimental drugs in the mistaken belief that the original treatment had been ineffective.
That's why James Sherman, MD, suggested physicians call their patients' pharmacies to see how frequently they have their prescriptions refilled. It's not a perfect measure of whether the medication is being used, he said, but if parents don't even acquire their children's prescriptions regularly, they must be falling behind. "Doctors are terrible at figuring out whether their patients are really taking their medicine," said Sherman, chief of the University of Florida College of Medicine's pediatric pulmonary division.
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"If you have [patients] whose condition is not being controlled, and you think they really are taking their medicine, then you begin to question the diagnosis, or you increase their dosage, try a stronger medicine or even switch to an experimental drug," Sherman said. "But if you know that the real problem is that they aren't taking their medicine, you can avoid all those efforts and instead work to try to understand why they aren't following your directions."
In a recent Florida study of 116 children with asthma, pharmacy-refill histories - obtained with the knowledge of the patients' caregivers - showed 43 had received fewer than half of their prescribed medication doses. Physicians, however, could only identify half of their noncompliant patients. The study was published earlier this year in the Journal of Pediatrics.
Previous studies showed 30% to 70% of the nation's 15 million people with asthma do not follow their prescribed medication regimen. Similar problems of "medication adherence" have been reported in other chronic conditions.
Physicians traditionally have relied on their clinical judgment to determine whether patients are taking their medicine, Sherman said. "They will ask the patient and family and make an assessment based on that. But often, doctors just aren't accurate," he said.
Almost by accident, Sherman and Leslie Hendeles, a professor at University of Florida's College of Pharmacy, thought of calling the family's pharmacy to determine compliance. They had been treating a child who was hospitalized with uncontrolled asthma. To clarify the list of medications the child was taking, Hendeles called the pharmacist, who mentioned that the child's asthma prescription had not been filled for more than a year.
"The mother had said he had been taking the medicine every day," Sherman said. In that case, the knowledge gained from the pharmacist prevented a lung biopsy to determine whether there were problems other than asthma.
Once a physician knows the problem is noncompliance, he or she can try to learn why. "Sometimes there has been a failure to communicate the importance of taking the daily medicine," Sherman said. "Sometimes a patient has real concerns about side effects, and you need to find something that doesn't frighten them. And occasionally, the patient may be on too complicated a regimen, so the solution to that might be a daily visit to a nurse who can offer assistance."
Mark Stein, MD, a West Palm Beach, Fla., asthma and allergy specialist familiar with the Florida research, said he found it helpful to call the pharmacist when he had questions about whether a patient is getting a prescription refilled as directed.
"I think most physicians wouldn't think of the idea," Stein said. "It can be cumbersome at times because it can take several phone calls to make the record check. But it's a good idea."
For more information:
- Sherman J, Hutson A, Baumstein S, et al. Telephoning the patient's pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions. J Pediatr. 2000;136 (4):532-6).
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