Ira Wilson, Cathy Schoen, Patrician Neuman, Sc.D.
An alarmingly high number of America's elderly are not talking to their physicians about problems they are having with prescription medications, including unwelcome side effects, costs, or perceived efficacy, finds a new study supported by The Commonwealth Fund and the Henry J. Kaiser Family Foundation.
According to the authors of "Physician–Patient Communication about Prescription Medication Nonadherence: A 50-State Study of America's Seniors" (Journal of General Internal Medicine, Jan. 2007), 40 percent of seniors responding to a survey reported not adhering to their "doctor's orders" regarding their medication regimens. Among those who gave a cost-related reason for not complying with their drug regimen, 39 percent did not talk to their physicians about it—even though lower-cost alternatives were available.
"This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans," according to the research team, which was led by Ira B. Wilson, M.D., of Tufts–New England Medical Center.
Sicker Seniors More Likely Not to Take Medicines as Prescribed
The researchers surveyed 17,000 community-dwelling Medicare beneficiaries age 65 and older who were living in low-income neighborhoods in all 50 states. Their findings illuminate the difficulties facing many elderly Americans: 32 percent of seniors reported three or more chronic conditions, while 41 percent use five or more prescriptions. Of those who use multiple medications, 54 percent have two or more prescribing physicians and 36 percent use two or more pharmacies. Thirty-two percent spend more than $100 per month out-of-pocket on medications.
Overall, 40 percent of survey respondents reported some kind of nonadherence. Medication noncompliance was more prevalent among seniors who reported three or more chronic conditions: more than half (52%) were not taking medicines as directed, including 35 percent who cited cost as a reason. The researchers did find that those with three or more chronic conditions were more likely to talk with their physician about all of their medicines than seniors overall (76% vs. 68%). "However, despite this trend," the authors said, "fully 24 percent of those with three or more chronic conditions had not talked with their personal doctors about all of the different medicines they were using in the last 12 months." Another disturbing finding was that 27 percent of those who skipped doses, stopped taking a drug because of side effects, or felt they did not need the drug failed to inform their doctor.
Good Communication Saves Money
Patients who discussed their medications with their physicians, the researchers found, were more likely to be switched to lower-cost drugs. Of those who had a discussion with their doctor about the cost of prescribed drugs, 41 percent were switched to a lower-cost medication, compared with just 12 percent of those who did not. This finding "suggests that such discussions are worth having," say the researchers. Physicians have a number of cost-reducing strategies available, among them, using generics, switching within- and between-class drug switches, reducing doses, and using samples. "None of the strategies, however, can be implemented if physicians and patients are not routinely discussing medication use and medication costs," they said.
The communication gap between physicians and elderly patients is wide: one-third (32%) of all seniors surveyed—and 24 percent of those with three or more chronic conditions—have not talked to their doctors about all of their medicines in the past 12 months. "These findings paint a sobering picture of prescription mediation taking for America's seniors," the researchers conclude. "Most seniors have multiple chronic diseases, take multiple prescription medication, have more than one prescribing physician, and use multiple pharmacies. In these circumstances, the need for improved physician-patient communication about medications is pressing."
While technology, such as electronic medical records and electronic prescribing, can help support efforts to increase the dialogue between physicians and patients, the researchers conclude that "more and better talk is needed." Quality measurement and quality-improvement initiatives focusing on prescription drug related communication could hasten progress.
Facts and Figures