In the pharmacy field, we typically promote the five R’s of medication administration to reduce potential errors. They are: right patient, right drug, right dose, right route of administration, and right time. These principles sound obvious, but they are limited only to how we dispense medication—not necessarily to how patients actually take their meds.
I once heard the story of a patient who was dispensed a suppository. He came back to the pharmacy after he had taken the medication for several days, complaining that it hurt when he inserted it and that he wasn’t feeling any better. It was the right patient, drug, dose, route and time—so what was wrong? Sometimes, the devil’s in the details; the patient was not aware that he was supposed to take the foil wrapper off the suppository before he took it.
Communication between patients, doctors, and pharmacists is critical to effective care. While the five R’s are certainly important, the patient must understand how to use the medications correctly. Recent studies show major discrepancies between what is prescribed and what patients actually take. To improve patient outcomes by ensuring patients take the meds they are prescribed and discontinue meds they no longer need, there is a newfound emphasis on compliance and adherence in healthcare.
It has been estimated that non-adherence to medication instruction can cost as much as $290 billion in avoidable medical costs. In addition, there is untold suffering that comes with patients getting the right medication. In the study referenced by Coletti, patients were asked about the medications they were taking prior to a specific appointment. This was then compared to each patient’s electronic health record (EHR). Of the 294 patient records reviewed, 260 had some discrepancy (89%). This included taking medications not on the EHR or not taking medications that were on the EHR. This doesn’t necessarily mean that patients were incorrect in their list but more that the physicians’ practice EHR and the patient lists did not agree. A large portion of these cases (57%) did involve active medications indicating therapy that should have been taken or discontinued. The Coletti study also indicated that lower wellbeing scores and multiple medications were predictors of discrepancies.
Other studies (view studies here and here) have shown that barriers to medication adherence involve patient-related (health literacy, age, or other psychological factors) or treatment related issues (side effects or drug costs). A recently published study shows that even when patients are discharged from hospitals, there were multiple discrepancies that could lead to non-compliance and further complications. While there is a need for more research on methods to avoid the growing issue of non-compliance, it is clear that the focus must be on medication therapy management (MTM)—mainly streamlining medications, and of course, effective communication between caregivers and practitioners.
