When Medications Fail to Work: Is It Pharmacological or Psychosocial?

Not infrequently, physicians find that their patients are not responding to the prescribed therapy. The elevated blood pressure doesn’t improve, the elevated blood sugars are not falling, the signs and symptoms of congestive heart failure are still present. The physician may scratch his or her head wondering why there was a lack of therapeutic efficacy. But it may not be that the prescribed medication wasn’t effective, it may be that the prescribed medication was not taken properly or even not taken. Pharmacists Kenreigh and Wagner posting in the Medscape web article about medication adherence report that a recent study “found that the risk of hospitalization was more than double in patients with diabetes mellitus, hypercholesterolemia, hypertension, or congestive heart failure who were nonadherent to prescribed therapies compared with the general population.” The article suggests that patients with chronic illnesses are more likely to fail adherence to a prescribed medical program than those with acute illnesses. In addition, issues of literacy of the patient should be considered as a factor.

There are a couple other factors involved in non-compliance not specifically mentioned in the article which should also be considered. One involves the doctor-patient relationship and the degree of confidence the patient has in the doctor. Doctors who don’t or can’t take the time to explain to the patient’s understanding the therapy and schedules could face non- or poor compliance response by the patient. Schedules are often an important factor in poor compliance especially if the schedules fail to take into account the patient’s individual scheduling problems. The other involves financial burdens placed on the patient and the decisions patients have to make with regard to how they allocate their available income to the various necessities.

One change in the system that is greatly needed is that the physician become more educated and kept updated on the cost of medications. Ask your doctor to tell you the cost of a drug. I bet he or she can't give you a spontaneous answer. It is a simple task to select a drug that has been shown to be potentially pharmacologically effective. But that is only one factor for the physician to consider. The other obviously includes the medical risks of the drug but yet another is the financial burden of the medication to the patient. That requires an knowledge of the cost of the medication and the financial status of the patient. Perhaps physicians should take time to also discussing this burden with the patient and, if necessary, prescribe a medication perhaps not as “new” or direct-to-consumer advertised which could be equally effective. But I just wonder how often physicians do that.

The reflex response by a doctor when a medication doesn’t seem to be working should not be to change drugs. It should be first to establish whether the patient is taking the medication or taking the medication as prescribed. And then, if this is the problem, the physician should try to mitigate it. ..Maurice.