Variety of reasons medicine not taken, a survey of seniors says

A new Medicare drug law can go only so far toward encouraging adherence to a medication regimen.

By Susan J. Landers — Posted May 9, 2005

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Washington -- Cost isn't the only reason elderly patients don't take all the drugs prescribed to them, say the authors of a large survey of Medicare beneficiaries.

Seniors were about as likely to cite a drug's side effects or their beliefs that the medications weren't effective as they were to cite high cost, according to findings published online April 19 in Health Affairs.

Physicians could find that the new prescription drug benefit for Medicare, which goes into effect next year, will go only so far toward ensuring that patients follow their medication regimen because, the new survey found, it's not just about the money.

About 25% of the 17,685 Medicare recipients who responded to the survey via mail and telephone said they had skipped doses or stopped taking a drug because it made them feel worse or it wasn't helping, and 26% said they had not filled a prescription, had skipped doses or had taken smaller doses because of cost.

In addition, about 15% of respondents said they thought they didn't need the medicines or they were taking too many drugs. Many of the responses overlapped.

It was surprising to find there are reasons beyond cost that lead people to stray from their prescription drug regimens, said lead researcher Dana Gelb Safran, ScD, director of the Health Institute at Tufts-New England Medical Center. "And these reasons need to be addressed in the doctor-patient encounter.

"The findings told us in part that while the new law could be very helpful in addressing issues of non-adherence, it's not going to take us the whole distance. There are other very important reasons that people don't adhere to their prescription regimen other than cost," Dr. Safran said.

All told, about four in 10 seniors surveyed nationally told the researchers that they hadn't taken all of the drugs their physicians had prescribed for them in the past year.

The survey also revealed that many seniors follow complex and costly drug regimens that could make adherence even more difficult. Of the 89% of seniors who reported taking prescription drugs in the past year, nearly half, or 46%, take five or more; more than half, 54%, have more than one physician who prescribes medicine; and about a third, or 35%, use more than one pharmacy.

Nearly three of four seniors, or 73%, who have at least three chronic health conditions, such as hypertension, high cholesterol, heart problems, diabetes or arthritis, take five or more medications regularly, and 42% spend $100 or more each month on them.

The survey was conducted in 2003, before the enactment of the Medicare Modernization Act, by the Kaiser Family Foundation, the Commonwealth Fund and Tufts-New England Medical Center.

"With two out of five seniors not taking medicines as prescribed, there is a real opportunity to improve patient care both by urging doctors and patients to talk more about these issues and by developing systems to monitor quality and safety," said Commonwealth Fund President Karen Davis, PhD. "These steps are an important complement to new Medicare prescription drug coverage."

The researchers also found that the lack of prescription drug coverage played a substantial role in adherence rates. Thirty-seven percent of seniors without drug coverage reported cost-related non-adherence, compared with 22% of seniors with drug coverage. Low-income seniors without drug coverage generally took fewer drugs than did those with it.

Nationally, slightly more than one in four seniors reported that they did not have any prescription drug coverage at the time of the survey. Rates also differed between states, with 35% of seniors in Louisiana and 36% of seniors in Washington reporting a lack of coverage compared with only 16% of New York seniors.

Among low-income seniors, one-third lacked coverage nationally, and in several states that number was more than 40%.

About one in 20 of all seniors, or 5%, reported obtaining prescription drugs from pharmacies in Canada or Mexico. Among those without drug coverage, 11% said they obtained drugs from those countries.

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Study highlights

A national survey of nearly 18,000 Medicare recipients elicited the following information:

  • Four in 10 seniors said they hadn't taken all the drugs their physicians prescribed for them in the past year.
  • Seniors were about as likely to say they stopped taking their medication because it made them feel worse or wasn't helping as they were likely to have failed to fill a prescription or to have taken smaller doses because of cost.
  • Nationally, slightly more than one in four seniors reported that they did not have any prescription drug coverage at the time of the survey.
  • Drug coverage made a substantial difference in adherence rates, with 37% of seniors without drug coverage reporting cost-related nonadherence, compared with 22% of seniors with drug coverage.

Source: "Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey," Health Affairs, Web exclusive, April 19

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