Researchers and advocates offer explanations for why patients may not take their medicine as directed and suggestions on what can help.
First, the discouraging news: In 2002, researchers from McMaster University Medical Centre in Canada described more than three decades of research on strategies to help patients take their medicine as directed. Their conclusion: “These provide little evidence that medication adherence can be consistently improved within the resources usually available in clinical settings,” they wrote in the Journal of the American Medical Association.
Joyce Cramer from Yale University, who has spent a career publishing studies on medication adherence, says every approach has the same hitch. “People are people,” she says. “At the beginning of the medicine, you’ve bought into the diagnosis and the need for treatment.” As the initial scare becomes distant, the drug’s significance erodes, until the day it doesn’t seem significant at all.
In more than 20 years of research, Cramer has found that technological innovations aren’t necessarily the answer. Just encouraging a plan for taking the pill—even something as simple as “every day at breakfast”—makes it easier to remember and to stick with the initial resolve. “You’re creating a contract with yourself,” she says.
More sophisticated approaches may help as well, though they require time and resources. Mary Lou Smith, co-founder of the nonprofit Research Advocacy Network, believes many patients can benefit from disease management, such as scheduling a nurse or other provider to regularly call, check on side effects, and give personal reminders. “Now you’ve got a nurse calling and asking, ‘Have you tried so-and-so?’ ” she says.
Drug companies and doctors’ offices have also experimented with automated telephone prompts, postcards, electronic pill bottles, and special packaging. While none of these have shown consistent or dramatic results, the result that matters to any individual is their own.
“It’s what you can do for yourself,” Cramer says. “And it’s what everybody who works in a medical office can do to help you.”
For some patients, a breakdown in medication adherence is more of a response to desired relief from side effects than remembering to take their pills. For others, it’s the side effect itself that creates a problem, specifically difficulty swallowing. Now, there’s Soltamox, a liquid formulation of the breast cancer drug tamoxifen, and Zensana (ondansetron), an oral spray for treatment-related nausea and vomiting.