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Drugs don’t work in patients who don’t take them: what the industry can do

Blogs are not edited by PJ staff*. The opinions expressed in this blog do not necessarily reflect those of The Pharmaceutical Journal.

*Blog pieces that have previously been printed in the PJ and Clinical Pharmacist are edited.

By Faiza Rafique
15 May 2011

The World Health Organization recently found that non-adherence to medicines is common in both developed and 3rd world countries (being worse in the latter). An obvious, yet overlooked statement from former surgeon C. Everett Koop concluded that “Drugs don’t work in patients who don’t take them” (1).

Although regular emphasis is put on patients from both doctors and pharmacists on the importance of taking medication regularly, completing the treatment and taking them accordingly, many fail to do so.  In a study of 206,604 patients who were given a new prescription for an antidepressant and who had not been taking an antidepressant for at least 6 months previously, less than 30% continued to take the medication for a full 6 months as required to do so (2). 

This then makes evident that 50-90% of patients do not take medicines accordingly and therefore lack effective treatment (3). The NICE guidelines state that 33-50% of medicines prescribed for long-term conditions are not taken as recommended, and that this can fall into two categories: intentional and unintentional non-adherence.

Intentional non-adherence is where the patient decides to not follow the recommended treatment. Unintentional non-adherence is where the patient wants to follow the recommended course of treatment but cannot do so due to practical problems (4). 

Doctors, pharmacists and other healthcare professionals have a responsibility to ensure that patients comply with medication they are prescribed. But although they do try to highlight the importance of completing the course upon prescribing and giving the medication, a lot of people still fail to adhere to it. This is where the pharmaceutical industry can interfere and help improve medicine adherence as well as decreasing health care costs and wastage.  

Pharmaceutical industries spend vast amounts of money every year on advertising the latest drugs, apparently spending more on advertising than researching drugs (5). I believe that because pharmaceutical companies spend so much money advertising new drugs to potential new patients, they forget to highlight the importance of the effects of premature withdrawal of medicine.

I think that although companies seem to think that there is greater profit from advertising the drugs, surely there is even more profit and hence a missed opportunity for not emphasising the importance of taking medication regularly, and completing a prescribed course.  

If drug companies stressed the severity of the consequences of non-adherence, more patients would comply to medication prescribed to them, and I think the way to go about this, is the way in which all well known companies have (such as cosmetic, perfume, household appliances) is through the media- television, newspapers, magazines, posters in shops such as Boots, Superdrug and other pharmacies. Prominence should be put on reminding the general public that medication will not only alleviate symptoms but continue to help them over duration of time.  

Television advertisements from drug companies could feature people who have been on long-term medication or more than one medication and broadcast their views on how they feel much better after adhering to the treatment set out to them. They could include success stories of common medications used and long-term benefits of using them. 

These advertisements could focus on common disorders such as depression, asthma, diabetes etc and the symptoms, importance of seeing their doctor and then the significance of long-term use of drugs and the benefits to one’s health. 

In addition to this, packaging can provide an increase in adherence as patients have better knowledge of the drugs. Upon researching and collecting information, I found that patients were regularly confused with the patient information leaflet and many do not even bother reading it. The patient information leaflet is extremely important, and I feel that non-adherence may be due to the fact that patients have either read it and have not taken it properly or at all as they are scared of the risks of taking the medicines, or they haven’t read it because it is a white piece of paper filled with black small print of what is complete medical jargon to them.

In this case the pharmaceutical industry could provide a more concise, user-friendly, and appealing patient information leaflet so that patients will read it and understand it. 

Drugs that are sent to the third-world countries (that obviously cannot pay as much for healthcare) cost a lot and the industry should subsidise the costs of these drugs, taking into account the situation of the country.

Paul Farmer did say that “It is clear that the pharmaceutical industry is not, by any stretch of the imagination, doing enough to ensure that the poor have access to adequate medical care.(6) 

In conclusion, it is important for the pharmaceutical industry to work with pharmacies to increase adherence. Information packages for drugs that require long-term usage could be made from the manufacturers in order to increase patient compliance and educate patients on their medication.

As well as this and that discussed above, I think it is extremely important to increase promotions of conditions, medicines and to use the media as a tool. The fundamental aim of the industry should be to ensure that patients adhere to the medication they are taking, are fully informed and get the best possible results from it. The pharmaceutical industry needs to make patient care their number one priority not just the money in their pockets, and I think that in doing so and increasing medicine adherence not only will the drug companies benefit but so will society as a whole.

References:

 

(1)- http://www.bmj.com/cgi/content/extract/327/7419/863?hits=10&FIRSTINDEX=0&FULLTEXT=Bonaccorso+S%2C+Sturchio+JL.+Perspectives+from+the+pharmaceutical+industry.+&SEARCHID=1&gca=bmj%3B327%2F7419%2F863 

(2) http://www.medscape.com/viewarticle/479965 

(3) http://blog.alensa.com/blog/?p=477 

(4) http://www.rpsgb.org.uk/pdfs/NICEmedsadhimplementguid.pdf 

(5) http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050001 

(6) http://www.brainyquote.com/words/ph/pharmaceutical202003.html

 

Non-adherence to medicines

Hi Faiza,

You might be interested in a report on medicines non-adherence from the International Pharmaceutical Federation congress 2010, which can be found here. The report on medicines non-adherence is on pF8.

Kind regards,

 

Benedict Lam

Editor - Tomorrow's Pharmacist

Thanks

Hi Benedict,

Thank you for the link I will definitely take a read.

Take care. 

Kind Regards 

FaizaR