If Cindy Nielson and her fellow pharmacists got a nickel every time a patient was "non-compliant," they'd all be rich.
Noncompliant means the patient doesn't complete a course of medicine. Or ignores the warnings about taking it with alcohol or other substances. Or adjusts his or her own dosage. Or takes medication intermittently.It's a quiet form of Russian roulette, since an estimated 5 percent of all admissions to hospitals are caused by noncompliance with prescriptions. And some patients die.
"I know there are factors, like economics," said Nielson, a pharmacist at LDS Hospital in the cardiology unit. She and Michael Barton, another IHC pharmacist, will answer questions about prescriptions, interactions and other pharmacy-related topics during Saturday's Deseret News/
Intermountain Health Care hotline. They will take calls from 10 a.m. to noon.
"Drugs are not cheap and not everybody has insurance. And if you're taking 10-plus medications, even with insurance, on a fixed income it's still a significant out-of-pocket expense," Nielson said.
Money's far from the only reason for noncompliance, she said. Many people don't understand the need for the medication and feel safe not taking it. Many diseases are "silent diseases," such as diabetes or high blood pressure. "You don't always feel them, so you don't see the need to take the medicine."
Self-medicating is "another potential problem," Nielson said. Especially in cases where people self-medicate and don't know about drug interactions or are treating the wrong thing.
Over-the-counter remedies have increased that potential, because patients sometimes choose not to bother busy doctors when they feel they can just take something themselves.
Often, Nielson said, noncompliance is actually a lack of education on someone's part. "If someone has asthma and has to get an inhaler, it maybe isn't clearly stated to the patient that when this is done, he's going to need to get a refill. Asthma is lifelong. It's not clearly stated, or it's not clearly understood. And we like to blame noncompliance on patients, but sometimes (doctors and health-care practitioners) are in a hurry. There's a lot of pressure to do more with less."
Nielson can point to specific damage she's seen when patients don't use their medications properly: The man who stopped taking his high blood pressure medicine and had a stroke. Now he's blind and has damaged kidneys. The woman who didn't take her insulin and ended up in the hospital seriously ill.
The medical industry estimates that the direct medical costs secondary to noncompliance is over $8 billion a year. And that doesn't include time off work and general lost productivity.
So Nielson has joined her industry in advocating good patient education. Patients need to know the name of the medication, why they are taking it, how to take it, possible adverse reactions and - if they miss a dose - how to handle it. Some medications you can make up a missed dose, but with others that could be deadly.
Nielson stresses the importance of going to the same pharmacy for medications, rather than being a "poly-pharmacy patient." Someone who fills a prescription for Coumadin (a blood-thinner) at her regular pharmacy shouldn't fill a prescription for an antibiotic, for instance, at another pharmacy without telling that pharmacist about medications (including over-the-counter remedies) that are being taken. Antibiotics interfere with Coumadin, for example. And some combinations create serious adverse effects.
Two pharmacists, Michael Barton and Cindy Nielson, will be featured during Saturday's Deseret News/Intermountain Health Care hotline. They will take calls and answer questions from 10 a.m. to noon. The toll-free number from anywhere in the intermountain region is 1-800-925-8177. All calls are confidential.