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Experiment Reveals Patient Difficulties Arranging Drug Regimens

Most subjects could not grasp how to group medications to optimize doses

When Chicago health centers evaluated the ability of older participants to group seven drugs in a medication box, most were not able to grasp how to combine them into four dosings. Instead, the majority of the 55-to-74-year-olds grouped the pills to take them six or seven times a day.

Two of the drugs carried identical instructions, but a third of participants didn’t realize that they could be taken together. Almost 80% didn’t understand that they could take two drugs together if one label read “every 12 hours” and the other “twice daily” — even though, in this context, they meant the same thing.

“We learn over and over again how challenging it is to maintain a drug regimen,” said Michael Wolf, an epidemiologist at the Feinberg School of Medicine at Northwestern University, who led the experiment. Medication adherence, a widespread public health concern, is a particular problem for older people. They take many more drugs than younger patients do — seven prescriptions is hardly unusual. Yet studies have repeatedly demonstrated that “the more times a day you have to take a medication, the lower your adherence,” Dr. Wolf said.

When patients can’t come up with a workable plan or can’t stick to a plan, unhappy consequences can follow. Drug A seems ineffective, leading a physician to add Drug B, when the real problem is that the patient simply misunderstood the dosage and wasn’t taking enough Drug A. Or an older patient simply throws up his hands over a complex regimen and remains unmedicated or undermedicated, risking serious illness.

“I see this stuff every day in my clinical practice,” said Dr. William Hall, a geriatrician who directs the Center for Lifetime Wellness at the University of Rochester in New York. “There’s tremendous possibility for confusion.”

Some of the reasons that older adults get their drugs wrong are tough to fix: cost, for instance. Despite Medicare Part D and the Affordable Care Act’s gradual closing of the “doughnut hole,” some older people just can’t afford to take medications as frequently as they are supposed to.

Medication therapy management, offered by private insurers that cover drugs, will review prescriptions, doses, costs, and other questions for older people who have several chronic conditions and take multiple medications. It could help them stay on track.

Still, it should already be easier to do that. “The wonder,” Dr. Hall said, “is that anybody gets it right.”

Source: The New York Times, December 18, 2015.

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