Patients' Understanding of and Compliance With Medications: The Sixth Vital Sign?

doi:10.4065/80.8.983

Mayo Clinic Proceedings

Volume 80, Issue 8, August 2005, Pages 983-987

https://doi.org/10.4065/80.8.983 Get rights and content

Section snippets

Physician Communication

Physician communication or the lack of it is probably one of the most important factors for patient noncompliance.6, 7, 8, 9, 10, 11 In the current issue of the Mayo Clinic Proceedings, Makaryus and Friedman¹² point out the difficulty physicians encounter with patient compliance. All of their 43 patients spoke English. Only 28% of the patients were able to list all their medications (mean number of medications was 3.89 per patient, but the authors did not mention what the percentage would be if

Patient Concerns

Patient concerns are numerous. An estimated 15% of the English-speaking people in the United States are illiterate, and another 15% are only marginally literate.¹⁶ This is a total of 90 million people (Institute for Healthcare Advancement, www.iha4health.org and http://foundation.acponline.org/healthcom/hli.hstm). Many of these people live in poverty, and one fourth have some physical and/or mental impairment. For another 15% to 20% of the US population, English is not their primary language,

The Sixth Vital Sign

The sixth vital sign can be defined by what the health care team knows, what is recorded regarding the medications the patient is taking or not taking, and whether the patient will take the medications as recommended—that is, is the patient truly compliant? Often, when a physician tells the patient to bring all his or her medications to the clinic or hospital, the patient brings them in one big container, not in the original containers. Conversely, the patient does not think, for example, that

Recommendations

Because of the tremendous costs and morbidity associated with the lack of education of the patient and in turn the far less than ideal compliance with the physician's recommendations, something must be done and done soon. This sixth vital sign is in dire straits. The United States is currently in a “Save 100,000 Lives” campaign (Institute for Healthcare Improvement [IHI] 100K Lives Campaign, www.ihi.org). Improving patient compliance will save some lives, maybe more than we will ever know. The

REFERENCES (25)

AN Makaryus et al.
Patients' understanding of their treatment plans and diagnosis at discharge
Mayo Clin Proc
(2005)
P Bissell et al.
From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions
Soc Sci Med
(2004)
R Balkrishnan
Predictors of medication adherence in the elderly
Clin Ther
(1998)
E Vermeire et al.
Patient adherence to treatment: three decades of research: a comprehensive review
J Clin Pharm Ther
(2001)
Task Force for Compliance
Noncompliance With Medications: An Economic Tragedy With Important Implications for Health Care Reform
(1993)
JA Johnson et al.
Drug-related morbidity and mortality: a cost-of-illness model
Arch Intern Med
(1995)
JC Hood et al.
Patient noncompliance can lead to hospital readmissions
Hospitals
(1978)
EI Williams et al.
Factors affecting early unplanned readmission of elderly patients to hospital
BMJ
(1988)
N Kerse et al.
Physician-patient relationship and medication compliance: a primary care investigation
Ann Fam Med
(2004)
RC Maly et al.
Implementation of consultative geriatric recommendations: the role of patient-primary care physician concordance
J Am Geriatr Soc
(2002)

N Williams et al.

The impact of matching the patient's vocabulary: a randomized control trial

Fam Pract

(2004)

E Krupat et al.

Choice of a primary care physician and its relationship to adherence among patients with diabetes

Am J Manag Care

(2002)

Cited by (28)

Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy
2010, Critical Reviews in Oncology/Hematology
Citation Excerpt :
However, patients often fail to take the correct dosage at the prescribed frequency and for the proper duration [10]. Awareness of poor patient compliance, persistence, and adherence has grown and has become the focus of an increasing amount of clinical research [11–14]. Compliance is generally defined as taking medication as directed (e.g. with or without food, at a certain time in the day); persistence, as continuing to take medications (correctly or incorrectly) for the recommended period; and adherence, as the patient's overall behavior, of which compliance and persistence are components [15,16].
Better compliance and persistence with therapy are associated with improved patient outcomes. As more and more patients survive breast cancer, compliance with adjuvant therapy becomes increasingly important. In clinical trials, compliance with adjuvant endocrine therapy among women with breast cancer is usually high. Retrospective analyses of databases and medical records from clinical practice, insurance databases of prescription refills, and survey data show a significant decrease in persistence after 12 months of therapy. With ongoing therapy, a further decline in persistence of up to 50% has been reported. A consistent methodology is needed to measure patient behavior and identify patients who are not adhering to therapy. Promising strategies for enhancing adherence to treatment in clinical practice include improving access to health care, increasing patient satisfaction, managing side effects, patient education, and better communication between the patient and health care provider. Positive relationships between patients and their health care providers, and frequent monitoring and feedback, may be most effective. While the lack of conformity across studies in measuring makes cross-study comparisons difficult, this review evaluates the available data regarding compliance and persistence with adjuvant endocrine therapies for breast cancer (tamoxifen and aromatase inhibitors) and presents strategies for improving adherence.
Beyond the medicine cabinet: An analysis of where and why medications accumulate
2008, Environment International
Active pharmaceutical ingredients (APIs) from medications can enter the environment as trace contaminants, at individual concentrations generally below a part per billion (μg/L). APIs enter the environment primarily via the discharge of raw and treated sewage. Residues of unmetabolized APIs from parenteral and enteral drugs are excreted in feces and urine, and topically applied medications are washed from skin during bathing. These trace residues may pose risks for aquatic life and cause concern with regard to subsequent human exposure.
APIs also enter the environment from the disposal of unwanted medications directly to sewers and trash. The relative significance of this route compared with excretion and bathing is poorly understood and has been subject to much speculation. Two major aspects of uncertainty exist: the percentage of any particular API in the environment originating from disposal is unknown, and disposal undoubtedly occurs from a variety of dispersed sources. Sources of disposal, along with the types and quantities of APIs resulting from each source, are important to understand so that effective pollution prevention approaches can be designed and implemented.
Accumulation of leftover, unwanted drugs poses three major concerns: (i) APIs disposed to sewage or trash compose a diverse source of potential chemical stressors in the environment. (ii) Accumulated drugs represent increased potential for drug diversion, with its attendant risks of unintentional poisonings and abuse. (iii) Leftover drugs represent wasted healthcare resources and lost opportunities for medical treatment.
This paper has four major purposes: (1) Define the processes, actions, and behaviors that control and drive the consumption, accumulation, and need for disposal of pharmaceuticals. (2) Provide an overview of the diverse locations where drugs are used and accumulate. (3) Present a summary of the first cataloging of APIs disposed by a defined subpopulation. (4) Identify opportunities for pollution prevention and source reduction.
Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients
2008, American Journal of Surgery
Citation Excerpt :
The present study did not investigate the specific reasons for refusal, but we were able to identify several factors related to noncompliance. Age has been consistently associated with patient noncompliance whether one measures compliance with blood pressure medications, adjuvant radiation therapy, or adjuvant chemotherapy.14 Our study found that older breast cancer patients were significantly more likely to refuse chemotherapy and radiation therapy.
There is little information on patient-driven noncompliance of adjuvant therapies and its consequences.
This retrospective study compares clinical, pathological features and outcomes of breast cancer patients who were compliant to recommended radiation, chemotherapy, and hormonal therapies to those who were noncompliant.
Noncompliance rates for chemotherapy, radiation, and tamoxifen were 31 of 421 (7%), 30 of 855 (4%), and 294 of (37%) respectively. Old age was associated with noncompliance to chemotherapy and radiation, but younger women tend to be more often noncompliant to tamoxifen. Noncompliance with chemotherapy or radiation did not significantly affect 5-year local and distant disease-free survival rates. Noncompliance with tamoxifen was associated with decreased 5-year local and distant disease-free survivals (87% versus 96%, 76% versus 87%, respectively, P < .001).
Noncompliance with tamoxifen is the most common, resulting in significantly increased risk of local and distant disease recurrence.
Impact of Adherence to Concomitant Gastroprotective Therapy on Nonsteroidal-Related Gastroduodenal Ulcer Complications
2006, Clinical Gastroenterology and Hepatology
Background & Aims The clinical impact of nonadherence to gastroprotective agents (GPAs) coprescribed with anti-inflammatory therapies has not been evaluated. In a large, commercial, managed-care database, we retrospectively characterized the use of GPAs among patients receiving nonselective nonsteroidal anti-inflammatory drugs (ns-NSAIDs) or cyclooxygenase-2–selective inhibitors (coxibs) and determined the impact of nonadherence on the likelihood of gastroduodenal ulcer complications. Methods Analyses identified the populations of patients with concomitant histamine-2 receptor antagonist or proton pump inhibitor (PPI) therapy and determined adherence with the prescribed therapy with respect to the duration of anti-inflammatory treatment. Multivariate regression analyses modeled the association between adherence with concomitant protective therapy and the likelihood of upper gastrointestinal (GI) complications including peptic ulcer disease, ulcer, and/or upper-GI bleed. Results Among 144,203 patients newly prescribed anti-inflammatory therapies, 1.8% received concomitant GPA treatment (ns-NSAIDs, 1.4% vs coxibs, 2.6%; P < .0001). The likelihood of GPA use increased with the presence of risk factors: age older than 65 years (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.3–1.5) and prior history of peptic ulcer disease (OR, 2.5; 95% CI, 1.8–3.3), esophagitis/gastroesophageal reflux (OR, 3.8; 95% CI, 3.5–4.1), ulcer/upper-GI bleed (OR, 1.4; 95% CI, 1.2–1.5), or gastritis (OR, 2.5; 95% CI, 2.2–2.8). Of patients receiving concomitant PPI therapy, 68% had adherence rates of 80% or more. A significantly higher risk of upper-GI ulcers/complications was observed in ns-NSAID patients with adherence rates of less than 80% compared with adherence rates of 80% or more (OR, 2.4; 95% CI, 1.0–5.6), but no such relationship was observed among patients who took coxibs. Conclusions Few patients receive concomitant GPA therapy when prescribed anti-inflammatory treatment, although use increased with the presence of risk factors. Adherence to concomitant therapy is paramount to reducing GI events among ns-NSAID users and educational efforts should be undertaken to promote use of and adherence to GPA therapy among these patients.
Barriers and facilitators in providing care for patients with a migration background
2023, Journal of Clinical Nursing
A Comprehensive Assessment of The Eight Vital Signs
2022, Eurobiotech Journal

View all citing articles on Scopus

View full text

EditorialPatients' Understanding of and Compliance With Medications: The Sixth Vital Sign?

Section snippets

Physician Communication

Patient Concerns

The Sixth Vital Sign

Recommendations

Mayo Clin Proc

Soc Sci Med

Clin Ther

Patient adherence to treatment: three decades of research: a comprehensive review

J Clin Pharm Ther

Noncompliance With Medications: An Economic Tragedy With Important Implications for Health Care Reform

Drug-related morbidity and mortality: a cost-of-illness model

Arch Intern Med

Patient noncompliance can lead to hospital readmissions

Hospitals

Factors affecting early unplanned readmission of elderly patients to hospital

BMJ

Physician-patient relationship and medication compliance: a primary care investigation

Ann Fam Med

Implementation of consultative geriatric recommendations: the role of patient-primary care physician concordance

J Am Geriatr Soc

The impact of matching the patient's vocabulary: a randomized control trial

Fam Pract

Choice of a primary care physician and its relationship to adherence among patients with diabetes

Am J Manag Care

Editorial
Patients' Understanding of and Compliance With Medications: The Sixth Vital Sign?