Changing Rxs (or Doses) Without Asking Basic Question

I’ve talked about this with many clients.  Since physicians don’t always engage patients in the basic dialogue around adherence, how can they decide to increase doses or change prescriptions simply if the patient’s condition isn’t becoming better?  This has to drive waste in the system. 

The reality is that a physician may get a lab value that shows that their patient’s cholesterol (or A1c or…) is higher than it was last time.  They know the patient is on a certain dose of the medication.  They instinctively think to increase the dose or change the medication.  BUT…they don’t always ask the patient about their adherence to the medication.  This is attributed to multiple reasons:

• They don’t see adherence as their issue.
• They assume the patient is adherent.
• They assume the patient would tell them if they weren’t adherent.
• They assume if they ask that the patient would lie to them and say they were adherent.

I’d heard about a study done about a decade ago that had looked at this, but it had never been published.  I was excited to see that Medco had published some research on this topic today. 

There were some interesting things in the research also.  It was another validation on the fact that men are more adherent than women.  And, it showed that people with multiple conditions were more adherent.  I would expect that there is a curve around this that people with a few medications and those with lots of medications are least likely to be adherent, and those somewhere in the middle are most adherent.  (But, I’ve never looked at the data with this question in mind.)