The basic tenet of non compliance is the failure to take medication according to prescribed directions. But it’s more than non adherence to directions, non compliance is also indicative of the misuse of medication. Many of us clinicians face these issues from time-to-time with our medicated clients, so let’s delve into this a bit more and see how you can help.

  • Side Effects. In a “perfect drug” scenario, medications would zero in on their intended target systems generating only desired, therapeutic effects. Unfortunately, it’s not that simple, as medications produce unintended consequences as well.

How you can help: It is important to be honest with clients about side effects. Point out that although practically every drug – prescription and over-the-counter – has side effects, many of them are short-lived and “run their course,” so to speak, after the body adapts to the new substance. Discuss the typical side effects of the medications that the client is taking, and suggest ways for combating them. For example, drugs with the side effects of anxiety and sleeplessness are best taken in the morning. Sedating medications should be taken at bedtime, and those linked to nausea are to be consumed on a full stomach.

  • Cost. Unfortunately, most brand name medications are outrageously expensive nowadays. So it is no surprise that the poor and particularly the elderly on fixed incomes are prone to breaking their medications in half or taking them every other day. As important as medication may be to quality of life and even survival, it’s not high in the pecking order when it comes to one’s hierarchy of needs.

How you can help: The place to start is with the client’s choice of insurance company or plan, if any. Help them find out about the range of prescription benefits and whether or not the medications they’re taking are covered. This is particularly important if they’re taking several medications.

Suggest comparison-shopping among several pharmacies. There are often disparaging price differences for the same drug from pharmacy to pharmacy. There are also a number of useful Web sites that can assist clients with comparison-shopping.

A number of assistance programs are available through states, nonprofits and drug companies. Contact the Partnership for Prescription Assistance at 888.477.2669 or www.pparx.org for eligibility requirements.

Find out if the client’s physician is willing to prescribe either a less expensive brand of the medication they’re taking or a generic. More and more pharmacies are following Wal-Mart’s lead and are offering some generics for as little as $4.00 per prescription.

The purchase of prescriptions via mail order, particularly in larger quantities, offers handsome savings in many instances. Client should be made aware that purchasing medication via internet pharmacies is a dicey proposition. Many of them provide no physical address or phone number and are possibly fronts for nefarious drug activity.

  • Forgetfulness. Forgetting to take medication according to prescribed directions is the most common cause of non compliance. We all forget to take our medication from time to time, but chronic forgetfulness is most often associated with poor organization and cognitive decline.

How you can help: Compartmentalized pillboxes, medication calendars, post-it note reminders, timers and even high tech talking devices that sound an alarm when a dose is missed are all helpful. The most effective plan though is to help clients set up a strategy for taking medications at the same time every day. Enlist the help of family members whenever possible. Available and supportive family members can either administer medications directly to the client or remind them via a phone call. The key here is to set up a clockwork pattern of daily repetition for taking medication.

  • The “I’m Cured” Syndrome. Way too many people treat prescribed drugs as they would a Tylenol for a simple, uncomplicated tension headache. That is, once their symptoms remit, they discontinue the drug. Most people want to be done with medication as quickly as possible because it is viewed as a nuisance. For many, having to take medication serves as an ever-present reminder of something undesirable, such as a physical illness or mental disorder.

How you can help: Clients need to be reminded that if medication has fostered improvement, then abrupt or even gradual discontinuation isn’t warranted without the approval or recommendation from the client’s prescriber. Simply, they shouldn’t take this matter into their own hands.

Non adherence to medication affects all age groups, turns a blind eye toward social stratification and is quite costly. According to the National Council on Patient Information and Education, medication non compliance alone leads to an additional $2000 a year per patient in additional office visits.

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Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.