Medication Compliance: Not A Money Issue?

It's no secret that adherence to medications is not great in America - or the rest of the world, for that matter. But you would think that if the medications were shown in numerous studies to actually save lives people would take them, right? And, if these patients had just had a heart attack then you would think that they would really take them, right? And if you offered these life-saving prescription medications to these heart attack patients for FREE then they would absolutely positively take them, right?

Wrong.

In fact, barely half of the patients who received prescriptions for standard, post-heart attack medications, free of cost, were filling them after one year. The other group, the ones who had to pay about $50 per month (the average copay) fared only slightly worse. 

Dr. Niteesh Choudhry of Brigham and Women's presented his study's findings Monday at an American Heart Association conference in Florida. They also were published online by The New England Journal of Medicine.

The study did not examine why people didn't take their medications, but was funded by Aetna (yes, that Aetna) in an effort to see if providing free medications would impart clinical benefit to their patients, and decrease long term costs as a potential aide effect.  But it appears money is not the major issue limiting medical compliance in this country.

As a physician, and a patient, I can attest to the fact that compliance with doctors' instructions is affected by so many things, money often playing a minor role.

Why is it so hard to take the medications doctors precribe? Is it because it makes us actually feel the opposite of healthy to take a medication? Is it that we're too busy? Too forgetful? Maybe it's because we can't actually feel the positive effects that it has on our bodies - there's no tangible reward like there are with dangerous drugs that we can't stop people from taking, e.g. weight loss pills and anabolic steroids.

Perhaps doctors have to do a better job explaining what it is that patients are ingesting and why these medications will help them down the line - even if they can't feel it.

Instead of subsidizing co-pays, perhaps insurance companies could spend that money on patient education or programs that reward compliance, encourage physical activity and emphasize healthy milestones.

Are you compliant with your medications? If not, why? Tell us what makes it so hard to follow instructions that should ostensibly improve your health.

The Future of Valve Replacments

Every year, tens of thousands of cardiologists, cardiovascular surgeons, and healthcare professionals gather to hear wonderful lectures from international experts, debate dozens of controversies in cardiology, and hear the latest study results in the Late Breaking Trials sessions.

One of this year's most interesting presentations at the American College of Cardiology (ACC) 2011 Scientific Sessions concerned the the replacement of aortic valves using a catheter from the groin arteries as opposed to open heart surgery. Amazingly, this relatively new and incredibly cool technology was shown to be just as good as the tried and true standard surgical method of aortic valve replacement for the primary end point of mortality.

"These results indicate that [transcatheter aortic-valve replacement] TAVR is an acceptable alternative to AVR in selected high-risk operable patients," said Dr. Craig Smith, the principle investigator for the trial. "Future randomized studies should focus on lower-risk patients who are candidates for operation."

Dr David Moliterno (University of Kentucky, Lexington), another panelist who was not involved in the study, told members of the press: "You really are witnessing history in the making. This is one of the biggest steps in cardiovascular medicine in our lifetime."

Interestingly, these procedures are only done at selected major cardiovascular centers across the country, one of which is The Gagnon Cardiovascular Institute at Morristown Memorial Hospital, the only hospital in New Jersey to do so.