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A Growing Epidemic: Patients "Miss" Doses of Prescribed Drugs on Purpose

BOSTON, Dec. 15 /PRNewswire/ -- Most patients who don't take their medications as prescribed aren't simply forgetting. Rather, they are actively choosing to disregard their doctors' orders, according to a report released today by The Boston Consulting Group (BCG).

According to The Hidden Epidemic: Finding a Cure for Unfilled Prescriptions and Missed Doses, almost one in every three patients surveyed reported having taken a medication less often than prescribed during the previous 12 months, and about one in four said they had delayed filling a prescription. Nearly one in five admitted that they had failed to fill a prescription during the same period. About one-fifth of the patients surveyed also stopped taking a prescription medication sooner than prescribed. A smaller but still significant group-about one in seven-took their prescription medication but in smaller doses than prescribed.

Of the patients in the survey who reported not taking medications as prescribed, only 24 percent cited forgetfulness as the reason. Most of the other reasons cited suggested an active choice not to comply with doctors' orders. For example, 20 percent of patients who forgo medications said they do so because they perceive a drug's side effects to be undesirable or debilitating, 17 percent because they find the medicines too costly, and 14 percent because they don't think they need the drug. This last group of patients view themselves, not their doctors, as the best ultimate judges of what medications they should take and when. Also among those actively not complying with doctors' orders are the 10 percent of patients who said they find it difficult to get the written prescription to the pharmacy or to get the filled prescription home.

The report also reveals that how and why patients make these choices vary substantially across segments of patients, depending on the nature of the illness, the patient's involvement in health care decisions, and his or her gender. But for all patients, missed doses often lead to greater health problems down the road, as untreated or undertreated conditions worsen or complications arise. In the aggregate, these behaviors translate into a sizable problem for society, particularly when they lead to higher hospital and nursing-home admissions, more invasive medical procedures, and the overall higher health-care costs that result.

"Improving compliance with prescribed regimens offers health care organizations-specifically, pharmaceutical companies, payers, providers, and pharmacies-a significant opportunity to improve both the physical health of their patients and the financial health of their own institutions," said Mark Lubkeman, a vice president and director at The Boston Consulting Group and an author of the report. "With profits squeezed and health care reform being hotly debated, these organizations now have a strong impetus to enhance compliance.

"Truly effective programs must find ways to address the root causes of shortfalls in compliance and coordinate multiple functions within a health care organization, while also engaging everyone from the doctors who write the prescriptions to the pharmacists who fill them," said Alastair Flanagan, also a BCG vice president and director and another of the report's authors.

The report outlines the unique role and perspective that each type of health care player will bring to this collective effort:

-- Pharmaceutical companies can rely on their vast sales organizations to educate doctors, as well as their direct-to-consumer marketing engines to educate both physicians and patients, about the barriers hindering compliance. They can also use these tools to encourage greater compliance. -- Providers can set the stage for compliance by emphasizing its importance and by addressing early resistance directly with patients during consultations. -- Payers, given their relationships with pharmaceutical companies, providers, and pharmacies, may be best positioned to help orchestrate compliance programs across the entire value chain of health care. -- Pharmacies, the last players in the health care value chain to interact with patients receiving new prescriptions, can use counseling, literature, and other media to drive home the value of compliance.

No matter where compliance programs originate, BCG explains that all successful ones will

-- rely on thorough knowledge of patient behavior to understand when and why patients don't take a specific medication -- create a program that uses coordinated input from all the parties that influence compliance decisions and ensures coordinated execution -- enroll patients in compliance programs as soon as they receive a prescription or get one filled -- deploy strategies that target the drivers of noncompliance, and exploit all the resources that influence compliance

Organizations that can master these issues will unleash significant value for their businesses, for medicine, and, most important, for patients.

The Hidden Epidemic draws insights from patients' responses to survey questions on compliance designed by The Boston Consulting Group in conjunction with Harris Interactive. The questions were fielded nationally by Harris Interactive using the Harris Interactive Chronic Illness Panel of online respondents. A total of 13,553 patients aged 18 and over were surveyed in April 2002; the data were weighted to the U.S. population of adults with specific chronic illnesses (covering more than 40 chronic conditions).

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Source: The Boston Consulting Group

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