Prescription drug use has significantly increased over the past several decades. As new drugs are discovered and new uses of older drugs are found, more and more patients are using medications to improve their health and quality of life. The Centers for Disease Control and Prevention (CDC) estimates that $234.1 billion dollars was spent by Americans in 2008 on prescription drugs. This was more than double what was spent 10 years earlier. Additionally, the World Health Organization (WHO) estimates that by year 2020, 157 million Americans will be affected by at least one chronic condition requiring prescription therapy. It is important for patients to avoid medication non-adherence and avoid adverse effects to experience the full benefits of treatment.
What is medication non-adherence?
Medication adherence is taking medications correctly. That means taking the right medication, at the right dose, and at the right time as prescribed by the doctor. Medication adherence also involves behaviors such as remembering to obtain refills, remembering to take medications on time, and understanding the directions for use. Non-adherence or noncompliance is not taking medications as prescribed. Non-adherence is one of the biggest issues in healthcare today.
Also Read: Reasons for Medication Non-Adherence
The adverse impact of non-adherence
Consequences of medication non-adherence include worsening illness, increases risk for other diseases (comorbid conditions), increased healthcare costs, increases risk for hospitalization, and death. One report by The National Community Pharmacists Associations (NCPA) estimates that non-adherence cost the American healthcare system $290 billion annually. Furthermore, 30 to 50 percent of treatment failures and 125,000 deaths each year are attributed to non-adherence.
Common reasons for medication non-adherence
Numerous factors contribute to poor compliance including:
- Not filling or refilling medications because they are too expensive
- Disbelief that the medication works
- Complex dosing regimens that make it difficult for patients to keep up with multiple medications
- Occurrence of unpleasant side effects
- Frequent changes in dosing schedule
- Lack of understanding or confusion about how and when to take the medication
Importantly, a recent study found that changes in pill color or shape may also be a contributing factor for non-adherence. Generic medications are frequently used to reduce healthcare costs. Many organizations mandate the use of generics to reduce the cost of medications. With generics compromising over 70 percent of all prescriptions dispensed, there is concern about the impact of switching between generic manufactures on patient compliance.
Also Read: How to Improve Medication Adherence
Recent study findings show that changes in the shape or color of generic pills may cause non-adherence
Generic medications are comparable or bio-equivalent (comparable in dosage form, strength, route of administration, quality, reason for use, and effectiveness) to the brand-name counterparts. However they have different colors or shapes which may lead to patient confusion or cause patients to stop taking their medications. One study was conducted to determine if switching between generic anti-epileptic (seizure medications) drugs was associated with higher rates of non-adherence. A US national database was used to analyze the prescription record of patients who began using an anti-seizure medication between 2001 and 2006. 11,472 patients (cases) were identified to be “non-persistent,” defined as patients who failed to fill their prescriptions within 5 days of the date required to take their medication. 50,050 patients who had no previous delays in getting their refills served as controls. Patients in the study received generic seizure medications of 37 different colors and 4 shapes.
Medication nonadherence was highest when there were changes in both color and shape of prescribed pills. Importantly, patients who were non-persistent were 27 percent more likely to have experienced a change in the color of their medication in their two previous prescriptions than controls. Furthermore, results of the study concluded that changes in pill color significantly increased the risk for nonadherence.
These study findings stress the importance of informing all patients of any changes in the appearance of their medications. Patients should check with their pharmacists if they have any questions about any changes in the look of their medication after a refill.
The importance of taking your medication exactly as prescribed
To experience the maximum benefits from medications, it is important for all patients to take their medication exactly as prescribed. Patients who skip their medications receive less benefit from their treatment and those who take more medications than prescribed may cause themselves harm.
Patients should understand the following details about their medication before starting treatment:
- Why they need the medication
- How and when to take it
- Storage information
- Side effects
- What to do if a dose is missed
- These and other medication related questions can be answered by your pharmacist.
Medication non-adherence remains a concern for the healthcare system. Taking medications correctly is a challenge for many patients, especially those who take multiple medications with complex dosing schedules. Taking medications incorrectly can significantly impact health and wellbeing.
Multiple factors can impact medication adherence. One recent study shows that changes in pill color or shape can cause patients to stop taking their medications. Any patient who is concerned about changes in the appearance of his or her medication should talk to their pharmacist or doctor before they stop taking their medication.
Brown M MD, Bussell J MD. Medication Adherence: WHO Cares? US National Library of Medicine National Institutes of Health. PMC.
Kesselheim A MD, Misono A, et al. Variations in Pill Appearance of Antiepileptic Drugs and the Risk of Nonadherence. JAMA Internal Medicine.
Mayor, S. Changing color of antiepileptic pills raises risk of patients’ non-adherence, study shows. BMJ. Published 03 Jan 2013.
Medication Adherence in America: A National Report 2013. National Report Card on Adherence. National Community Pharmacists Association NCPA.
Nauert R PHD. Color of Generic Drugs Impacts Medication Compliance. Psych Central.
Qiuping G, Dillion C, et al. Prescription Drug Use Continues to Increase: U.S. Prescription Drug Date for 2007-2008. National Health and Nutrition Examination Survey (NHANES). NCHS Data Brief. No.42. September 2010.
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