As she ended their phone calls, Santina Nato would always ask her mother, Carmela, whether she had taken all of her medications for the day. It was a constant worry since the 85-year-old from Toronto was juggling 12 different oral medications to manage various chronic conditions, including type 2 diabetes and high cholesterol. Deciphering the instructions on a dozen different bottles was often confusing, especially since English is not Carmela’s first language. Doses were missed, or taken incorrectly, which would contribute to periodic falls causing injuries.
Five years ago, Carmela’s doctor and pharmacist suggested trying blister packs to neatly organize all of her medications in one place organized by day and the time period when they needed to be taken. It’s easy for Carmela and for her son, who helps care for her, to see if a dose was skipped.
For her daughter, who lives an hour away, this new tool has meant a world of difference and her mother’s health has become more stable. “Having a much less complicated way for my mother to take her medications has lessened everyone’s anxiety,” says Santina. “Even when I can’t be there, especially during COVID, I know that she is able to take care of her health. We all felt like we had some peace of mind again.”
An urgent health crisis
Diabetes is one of the top chronic conditions where there is a lack of medication adherence, along with hypertension and mental health issues, like depression and anxiety. Non-adherence is a problem for many with 50 per cent of Canadians not taking medication as directed. That’s an issue, especially for older adults who tend to use more medications, which increases the risk of medication non-adherence. With the number of Canadians over age 65 and older set to double over the next 25 years and 9.8 million Canadians estimated to be living with chronic disease by 2036, the stakes are high, prompting some healthcare experts to call it an urgent healthcare crisis.
The ramifications of non-adherence can be widespread and serious, from increased healthcare costs to higher rates of hospitalization. It is estimated that drug non-adherence is the cause of 10 per cent of all hospital admissions. A further 26 per cent of hospital readmissions were medication related and of those 48 per cent were tied to non-adherence.
“In my experience, we see it all the time,” says Rose Patodia, a board-certified geriatric pharmacist, based in Vaughan, Ont. “Non-adherence is common. It’s not just about people not following instructions or not taking their medications, but it might be about doing it incorrectly. It’s a vital issue to tackle.”
Why medication adherence matters
If you do not take medication as prescribed, and then see your doctor or go for lab tests to check your progress, your noted response to treatment may be inaccurate. A doctor may decide to increase your dosage or add another medication, even though it may not be necessary. “Monitoring is based on the assumption that patients are following instructions as outlined,” she explains. “Doctors don’t necessarily know that the patient hasn’t been taking their medication as prescribed. When they don’t have that information about adherence, you can see how it can be an issue for whomever is prescribing or adjusting the therapy.”
Pharmacists play a central role in patient education. They can talk about what the medication prescribed is for, what it will do, when it will work, potential side effects and how to manage them. They are in a good position to identify non-adherence and why it’s occurring and offer solutions, from blister packs to support services, like in-home visits.
Alice Watt, a senior medication safety specialist at ISMP Canada and a consulting pharmacist, also recommends that patients communicate with their physicians. “Sometimes it’s a good question to ask the doctor whether they need to keep taking a certain medication,” she says. “It could be reassessed with the patient and their healthcare team. There are a variety of different reasons why patients may not take the medications and it’s imperative to understand why. We really believe in partnering with patients. If they’re involved in making decisions, they’re more likely to stick to the plan.”
To manage medications, she suggests that patients can use tools and technology available, like a MedsCheck with their pharmacist at no charge. This can be done annually, or under special circumstances, like being recently discharged from a hospital. Watt cites a recent study done in Quebec that saw one in four medication changes were not adhered to 30 days after a hospital discharge, and 27 per cent of new medication prescriptions not filled.
Innovative tools to help
There are additional tools that Watt recommends to encourage patient adherence, including ISMP’s 5 Questions to Ask About Your Medications, which was co-developed with patients and many partners. More new tools and technologies are becoming available to help you, your family, doctor, nurse, pharmacists, and anyone involved in your healthcare to keep track of medicines that you, as well as your family members, are taking. This includes sending reminders for when to take medication and confirmations that doses have been taken.
Other valuable resources include pharmacies and care providers. Most have their own medication management tools and monitoring platforms, which provide Canadians with more ways to manage their health and ensure adherence. Empowerment is the key. And as the number of older adults grows in Canada, they’ll be a driving force behind more positive changes to come.
Sponsored by Jones Healthcare Group.