Have you ever found yourself in this situation? I know I have over the years and it is easy to do when things around us get hectic. Recently, we all have gone through changes in our day to day lives with the pandemic so no doubt you have had to establish some new routines. Perhaps you always took your medication when you got to work, or when you had your first cup of coffee at work, but now you are home with the family, trying to keep children busy and it isn’t easy establishing a new routine. I am sure you are not alone but you realize that missing your medication is not a good option and wonder what can happen if you do forget your medicine from time to time. Today I will talk about Medication Non-Adherence and its potential risks. I will offer some reasons why this may be happening and discuss your role as a patient to improving this problem.
ADHERENCE
Adherence is defined by the World Health Organization (WHO) as “the extent to which a person’s behaviour- taking medication, following a diet, and/or executing lifestyle changes-corresponds with agreed recommendations from a health care provider. (2003)”
NON-ADHERENCE
“Non-adherence is defined as either the intentional or unwitting failure to take medications as prescribed. By not following directions correctly you increase the risk of decreased effectiveness of the medication leading to worsening of your condition (diabetes).” There are many publications that talk about non-adherence and the costs to the health-care system as well as of the harm to the patient. Statistics Canada claims that the rate of non-adherence to diabetes medications is 48%.
A former US Surgeon General Everett Coop is known for his famous quote “Drug’s don’t work in patients who don’t take them” and even though this was stated many years ago the same is true today. The medical team cannot help you if you avoid or take less medication than prescribed.
Another article that I read concluded that patients with type 2 diabetes who miss 20% of their anti-diabetes medications during one year are at an increased risk of hospital admission in the following year. Take a minute to think if you missed brushing your teeth 20% of one year that would be 72 days a year or 6 days a month or 1 ½ days a week. We know what the dentist and hygienist would tell us about our oral health. A previous blog of mine discussed dental issues in those of us with diabetes.
Multistep process
Sticking to a medication routine is complex and many factors contribute to being either adherent or non-adherent or just forgetting from time to time. There can be several reasons for non-adherence, it is usually just not one cause. Adherence is very challenging.
Possible reasons of non-adherence: Can you identify with any of these?
You do not understand the disease and the complications that may happen if control is not achieved in a timely manner.
You do not know how to take the medication -have you been taught how to give insulin or do you not understand the dosing of an oral medication.
You have heard stories about low blood sugars and driving or performing hazardous tasks so you decide to avoid this by not taking the medication rather than explaining this fear to their care providers such that it can be managed.
Denial-you have not been experiencing any symptoms so you don’t believe you are sick.
You don’t trust your health care provider and don’t want to ask for someone else.
You believe natural products are more effective.
You believe that the complications of diabetes will not affect you.
You cannot swallow pills; the bottle may be difficult to open but you don’t want to ask for another type of bottle or container or if another type of drug would do the same thing that is easier to swallow.
You forget to take the medication when your daily activities have changed or you have noticed that you are forgetting things more than normal but don’t want to tell anyone.
You have no drug insurance and cannot afford the medication but are shy to tell anyone.
Health care providers have a responsibility to help you improve your adherence and ability to take medications on a routine basis. They can help to :
1)simplify your medication schedule
2)help choose a pill organizer
3)involve you in the decision making
4)increase your access to a Diabetes Clinic or Diabetes Educator between your doctor appointments
5)help you understand the course of the disease and potential complications
6)make appointments more convenient for you to attend (virtual appointments)
7)listen to your concerns and help you navigate through those concerns
Your responsibility in this multistep process includes:
Filling and picking up the prescription at the pharmacy.
Taking time to read the directions and review it with the pharmacist. Sometimes doctors may say take 1 pill a day but they write the prescription for 1 pill twice a day which leads to more confusion. Confirm the instructions for use before leaving the pharmacy.
Taking the correct medicine in the right dose and in the correct manner. If it says not to crush or break the tablet in half then it should not be done.
Taking the medication until it is finished or the doctor tells you to stop. Antibiotics are usually prescribed for a few days as compared to a diabetes medication that could be long term.
Always take the right amount of drug. Too much can cause serious side effects and harm and too little can make the drug ineffective
If necessary, ask your pharmacy to blister pack your medications or organize them yourself in a weekly pill container.
Seek help/advice when in doubt about any medication.
A report by Diabetes Canada states that from “2010-2017, the number of Canadians living with diabetes increased by 28.7%. There are more than 3 million Canadians diagnosed with diabetes and its possible another 2 million live with diabetes but don’t know it, and 6 million more are living with prediabetes, placing them at high risk of developing type 2 diabetes. “ The same report tells us that “Canadians living with diabetes spend $1.8 billion on diabetes medication every year.” We are not alone in this battle. We need associations like Diabetes Canada, American Diabetes Association and the Federal and Provincial Governments and insurance providers to help us stay healthy. However, we must do our part by learning as much as we can about the disease and potential long-term effects; take our medication as prescribed and be actively involved in our own care and ask for guidance when things get tough.
Consequences of missing medication frequently could include any of the following or a combination of them:
1) Blood glucose values out of range for prolonged periods of time can increase the risk of you developing long term diabetes complications affecting the heart, kidney and vision to name just a few.
2) Increase the risk of Diabetic Ketoacidosis- a very serious condition that requires hospitalization .
3) Frequent infections which could cause hospitalization and long term antibiotic treatment.
4) Poor circulation that could lead to an amputation.
5) Increase symptoms of diabetes such as increase thirst and urination.
Any of the above will affect your quality of life and perhaps your income thus less security for you and your family.
Pharmacists are one the easiest health-care providers to gain access to as they work long hours and there are usually several pharmacies located in small and large communities. You should always try to deal with the same pharmacy so they can check your complete drug list and make sure you are not getting a duplication of therapy or if so they can make sure that it is intentional. Never hesitate to call and ask a question as they can certainly be a wonderful resource for you.
Your health care providers can provide you with specific information about each of the medications you take for diabetes and what could happen if one dose is missed occasionally.
Thank you once again for your attention to today’s blog. I hope it has helped to answer and/or raise a few questions in your mind. I welcome any new ideas for topics and feedback is always appreciated.
References: All information has been taken from the links associated with the words underlined in the document above. All accessed between July 14-30th/2020.
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