Adherence to medication and treatment guidelines: most important, but often overlooked (2023)

Alumni, Faculty of Pharmacy, University of Dhaka, Bangladesh

*Corresponding author:Abdul Kader Mohiuddin, Alumni, Faculty of Pharmacy, University of Dhaka, Bangladesh, Tel: +01935183385, ORCID: 0000-0003-1596-9757, Web of Science Researcher ID: T-5428-2019; The e-mail:[email protected]

Reception date:December 1, 2022

Publication date:December 21, 2022

Quote:Mohiuddin AK. (2022). Adherence to Medication and Treatment Guidelines: Most Important, But Mostly Overlooked. Mathews J Pharma Sci. 6(1):12.

Copyright:Mohiuddin AK. ©(2022).

RESUME

To cure any disease, it is necessary to use the medicine properly or to take the medicine in the correct order. Even patients in developed countries struggle to maintain medication adherence. There is a strange parallel between the emerging underdeveloped nations and the so-called developed world in the West when it comes to drug abuse. Understanding and perception of the disease is the most important factor influencing patients to adhere to their treatment plan.

Keywords: Medication non-compliance, patient non-compliance, avoidable medical costs.

ABBREVIATIONS

Adverse Drug Reactions (ADRs)

Blood pressure (BP)

Non-steroidal anti-inflammatory drugs (NSAIDs)

The Centers for Disease Control and Prevention (CDC)

World Health Organization (WHO)

INTRODUCTION

To cure any disease, it is necessary to use the medicine properly or to take the medicine in the correct order. According to the WHO, non-adherence to therapeutic schemes generates great problems for patients, especially those with chronic diseases. The "correct administration" depends on at least 5 correct factors: correct patient, correct drug, correct time, correct dose and correct route [1]. "Medications just won't work if you don't take them correctly": Most people around the world don't understand this simple fact, and as a result, more than half of chronic disease patients in the developed world don't take their medicines . correctly, according to the WHO [2]. Patients with chronic illnesses may find it difficult to adhere because their medications must be taken over a long period of time, sometimes for the rest of their lives. Patients can have difficulty adhering to treatment regimens for a variety of reasons, and the CDC estimates that medication non-adherence accounts for 30-50% of chronic disease treatment failures. Poor adherence can lead to treatment failure, worsening of symptoms, and deterioration of health [3].

Figure 1.Non-adherence to medication and possible results.

Non-adherence in so-called developed countries

In the UK, up to 50% of medications are not taken as prescribed and 60% of NHS patients do not receive adequate treatment within 18 weeks [4-6]. In patients with chronic diseases, nonadherence to medications leads to worse health outcomes, higher healthcare costs, more hospitalizations, and even higher mortality rates [7]. Medication nonadherence alone accounts for at least 10% of hospitalizations in the US, 250,000 hospitalizations in Australia, and 1.1 million hospital days in France (Figure 1) [8-10 ]; causes $300 billion in annual medical costs in the United States and $125 billion in the European Union; and causes more than 1,25,000 premature deaths in the United States and 2,00,000 deaths in the European Union [8,11,12]. Furthermore, two thirds of drug-related hospitalizations in Australia are potentially preventable [9]. According to a recent Canadian study, 30% of patients stop taking their medication earlier than recommended and 25% do not comply with the prescription or take less than prescribed [13]. Nonadherence to medication attributed to $679-$898 more avoidable expenses among patients who had at least one avoidable encounter [14]. However, pharmaceutical companies around the world lost $637 billion in potential sales due to non-adherence, with $250 billion lost in the US alone last year (Figure 1) [15].

Misuse of antibiotics

More than half of all antibiotics sold worldwide are sold without a prescription, and the CDC reports that 30-50% of antibiotics prescribed in hospitals are inappropriate or unnecessary [16,17]. According to a recent Lancet study funded by the Bill and Melinda Gates Foundation and the Wellcome Trust, nearly 5 million deaths worldwide in 2019 were caused by bacterial resistance, which is expected to double by 2050 [18]. In South Asia, nearly 70% of hospitalized patients received one or more antibiotics, while 100% of ICU patients received antibiotics [19,20]. However, between 70% and 80% of patients with COVID-19 have received multiple antibiotics for the treatment of COVID-19 [21-23]. The most frequently prescribed antibiotics were azithromycin, ceftriaxone, amoxicillin, metronidazole, and amoxicillin-clavulanic acid [24]. Furthermore, it has been reported that around 90% of patients with COVID-19 are being treated unnecessarily with antibiotics and almost 100% of these prescriptions were empiric [25].

NSAID abuse in patients with COVID-19, Dengue and Chikungunya

NSAIDs are responsible for at least 650,000 hospitalizations, 165,000 deaths, and 30% of ADR-related hospital admissions worldwide each year [26,27]. Excessive use of this class of drugs can lead to kidney damage, and its side effects can be three to four times more severe in patients with kidney disease [28]. Many studies have found that these drugs are widely used in patients with dengue, chikungunya, and Covid-19. It is even more important to keep the body hydrated than to lower the fever with painkillers, especially in patients with Dengue or Covid-19. Excessive use of paracetamol syrup or suppositories in children can cause gastric irritation, which can lead to vomiting and hospitalization. With a few exceptions, most hospitalizations or ICU admissions among these patients could be avoided simply by stopping dehydration at home with saline and fruit juice or by simply drinking more water [29].

A new era of rampant prescription and recreational drug use

Sleep disturbances are reported by approximately 40% of Covid-19 patients. Benzodiazepines increase the risk of delirium in patients with Covid-19, depress the system in patients with compromised respiratory functions, and are contraindicated with some antiviral drugs [30,31]. Surprisingly, the distribution of benzodiazepines increased dramatically in Canada between 2020 and 2021, while the abuse of similar drugs more than doubled in Italy [32]. According to the American Journal of Public Health [33], approximately 300 metric tons of morphine-type pain relievers are used worldwide each year, with less than 1% distributed to low- and middle-income countries. As a result, the developed world retains its misuse and associated side effects. Leading up to the US mid-term elections, an announcement by authorities about the “simple possession of marijuana” for thousands of convicted citizens ignited recreational drug abuse in the US and the EU [34,35].

Negative attitude towards the Covid-19 vaccine

A cross-sectional study of 259 school leaders in Hong Kong conducted during the COVID-19 pandemic between April 2021 and February 2022 shows that more than 50% of the participants had limited health literacy, which was strongly associated with a negative attitude towards vaccination, confusion about information related to COVID-19, and secondary symptoms [36]. Previously, a 2020 US study found that two-thirds of Americans will not receive the COVID-19 vaccine when it first becomes available, while 25% report they have no intention of getting vaccinated anytime soon. term [37]. In India, vaccine reluctance was high in Tamil Nadu, over 40%, and willingness to accept the vaccine was close to 90% in Kerala [38,39]. Another survey of vaccine hesitancy from University College London, UK, found mistrust among 16% of respondents and 23% were confused [40].

Medical cost and low health literacy: the two main barriers to adherence in patients with diabetes

A strange similarity can be found in underdeveloped and developing countries and the so-called developed world in the West or the Middle East when it comes to not taking medicines correctly. According to a WHO report, only half of patients in developed countries adhere to treatment guidelines for chronic diseases, which is much lower in developing countries [41]. Several studies among diabetic patients in South Asian countries have shown that almost half of patients do not adhere to prescribed medication and are at risk of acute and long-term complications, resulting in increased rates of hospitalization and medical costs [42, 43]. “Medical costs are barriers to compliance with appropriate clinical guidelines for chronic diseases in poor countries”, although they are discussed in many forums, but forgetfulness, confusion about the required duration of drug use and mistrust about the effectiveness General medication are some of the reasons. for non-compliance with diabetes control protocols in Middle Eastern countries [44]. Health literacy and medication adherence are strongly associated (Table 1). Poor glycemic control due to low health literacy among patients with diabetes reported in Southeast Asian and Middle Eastern countries [45-51].

Humanitarian crisis: Poor blood pressure control among heart patients

A recent study by the American Heart Association revealed that patients with high blood pressure do not follow treatment guidelines due to: (a) suboptimal doses or incorrect prescription of medications (b) lack of insurance or lack of access to medical care, and (c) patient non-compliance with prescribed medication or other lifestyle guidelines [52]. Among hypertensives, less than 50% have persistent BP control, although more patients received treatment over time. In addition, inadequate BP control has been reported among those with elevated total cholesterol, LDL, and uric acid levels in high-, low-, and middle-income countries [53]. The humanitarian crisis is associated with increased short- and long-term cardiac morbidity and mortality and increased BP [54]. For example, hypertensive patients with diabetes mellitus were twice as likely to have poor blood pressure control as in war-torn Palestine [55]. Additionally, a US survey of resettled Rohingya refugees from Myanmar shows a higher trend of chronic diseases such as diabetes, hypertension, and obesity [56].

Superstitions: an elephant in the room

Epilepsy and schizophrenia are still seen in most countries of the world as an evil spirit; although two-thirds of patients can be seizure-free with appropriate treatment, failure to adhere to appropriate regimens is a major problem for effective recovery [57, 58] . In a study conducted in India, 60% of patients believed in luck and superstition in relation to disease [59]. Superstitions have also been reported in about 40% of men and 70% of women in northern Germany [60]. In Africa, 70% of people resort to indigenous treatments such as spells and witchcraft to treat their illnesses [61]. Shockingly, more than 40% of Americans believe in spiritual treatment, and researchers have found that 73% of addiction treatment programs in the US include a spirituality-based element [62, 63]. The phobia was the cause of insulin rejection among 60% of diabetic patients despite medical recommendations, as found in a study conducted in southern Iran [64].

Pediatric and geriatric complications of non-adherence

Due to multiple physical complications and additional medication burden, three quarters of geriatric people worldwide are unable to adhere to appropriate long-term treatment regimens (Figure 1) [65]. Patients over the age of 65 who are taking at least five medications are at increased risk of mild cognitive impairment, memory loss, falls, frailty, impairment, and death, while ADRs are estimated to account for 5-28% of cases severe geriatric disease. admissions [66, 67]. For children, common non-adherences are related to family routines, parenting problems, and social problems such as poverty. Long-term conditions such as asthma, cystic fibrosis, HIV, diabetes, inflammatory bowel disease, and juvenile arthritis are attributable to approximately 60% of nonadherence among children [68-70].

Tabla 1.Several reasons identified for non-adherence to treatment guidelines for chronic diseases [7,71-73].

Tools to improve adherence to medication and treatment guidelines

There is evidence that the number of chronic diseases and medications increases non-adherence. The management of chronic diseases requires continuous psychological adaptation through behavioral, educational, integrated care, self-care, and risk communication interventions, which can result in significant changes in therapeutic indications. In addition, several newer technologies have been incorporated that may improve adherence to treatment and medication regimens.

Mesa 2.Interventions to improve adherence to treatment guidelines.

CONCLUSION

Finally, it can be stated that the patient's knowledge and interpretation of the disease are the main factors influencing adherence to the therapeutic scheme. Health professionals should explore more effective health education methods to identify patients' attitudes toward illness, trust in medicine, psychological stressors, and increase medication adherence.

RECOGNITION

I am grateful to Daniel B. Mark, MD, Duke Clinical Research Institute, Duke University Medical Center, North Carolina, USA, for his valuable time reviewing my article and for his thoughtful suggestions. . I am also grateful to Dhaka University College of Pharmacy Seminary Library and Bangladesh BANSDOC Library for providing me with books, magazines and newsletters.

FINANCIAL DISCLOSURE OR FUNDING

N/D.

CONFLICT OF INTERESTS

The author declares that he has no conflicting interests.

INFORMED CONSENT

N/D.

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