Do your patients adhere to doctors’ orders?

A guide to taking prescription medications

The following guide is designed for anyone who has an interest in seeing that a patient adheres to his or her prescription medication program. Whether it’s the patient who takes multiple prescription medications and has trouble remembering what to take and when, or a family member or friend who cares for the patient, it can serve as a valuable tool in ensuring that the medications are taken properly and that the appropriate medications are prescribed. Published by the National Council on Patient Information and Education (NCPIE) and the Agency for Healthcare Quality and Research (AHQR), this guide has been altered slightly for the home health care agency to use as a patient resource.

Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. Whether you are using a medicine yourself or helping a friend or family member, it is easy to get off track. Perhaps you did not take all of your medicine because you started feeling better, did not have a prescription filled or refilled (and did not tell your doctor), forgot to take one or more doses a day, or took more or less medicine than your doctor told you to take.

Get involved, stay involved

It’s important that you work with your health care professionals before, during, and after taking medicines so you can give them the information they need to help you and so that you can get information and help if you need it.

Why should you take this active role? Because using medicines in the right way is very important to your health. With proper use of medicines, you can:

• Get the medicine’s full benefits. For example, if you take too little of a medicine to lower your cholesterol level, you will not reduce your cholesterol as much as you could.

• Avoid dangerous problems. Some people end up at a hospital emergency room because they took too much or too little of a medicine, took it the wrong way, or mixed the wrong medicines, foods, and drinks. Improper medicine use can make you worse instead of better. Most medicine problems can be avoided or solved if you talk with your health care professional about what is happening.

• Reduce your chances of having side effects.

• Take greater control of your life. Decisions you make about your medicines can affect your schedule, your diet, your finances, and other parts of your daily life.

What you should do

Step 1: Take part in decisions about your treatment. It’s important that you take part in your treatment decisions, so don’t be afraid to ask questions and talk about your concerns. You may want to write down questions to ask at your next visit. By taking a moment to ask questions now, you may avoid problems later. Each time a new medicine is prescribed, you should ask about all parts of your treatment, including diet changes, exercise, and medicines; about the risks and benefits of each medicine or other treatment you might get; and how often you or your doctor will have to check your medicine’s effects. For example, this means checking your cholesterol level if you are taking a medicine to lower it.

You need to do more than ask questions, though. Your health care provider will also want to know some information about you. Be prepared to tell him or her:

• All the medicines you are already taking. This includes prescription medicines and the medicines you buy over the counter, such as aspirin or laxatives. Then your doctor can avoid giving you a new medicine that may not work well with one you take now.

• What is important to you about your medications. You may want a medicine with the fewest side effects or the fewest doses to take each day. You may be concerned about cost, or how the medicine might affect how you live or work. Or you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you.

• If cost is a concern. There may be a generic drug or another lower cost medicine you can take.

• If you have any medicine allergies, or if you have had troubling side effects from a medicine.

• If you are or might become pregnant, or if you are nursing a baby.

• Any illnesses or problems for which another doctor or health care professional is treating you.

You have the right to ask questions of your doctors and health care professionals, so don’t be afraid to "bother" them with your concerns. You need to understand and feel comfortable with your treatment plan. If you don’t feel comfortable talking with your physician, talk to your home health professional or a pharmacist — they can help you get a treatment plan that is right for you. Or, you may want to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well.

Step 2. Follow your treatment plan. To follow the treatment plan you and your doctor agree on, ask questions and tell your health professionals your needs and concerns. The doctor may start by giving you some directions for taking the medicine. Use the list located in this document under "Questions to ask about your medicine" to write down answers you receive about the medicine. If you need more information, you can ask your doctor, pharmacist, or home health care professional.

Here are some points to cover:

Ask:

• The name of the medicine and what it is supposed to do.

• How and when to take the medicine, how much to take, and for how long.

• What food, drinks, other medicines, or activities you should avoid while taking the medicine.

• What side effects the medicine may have and what to do if they occur.

• If you can get a refill and how often.

• About any terms or directions you do not understand.

• What to do if you miss a dose.

• If there is written information you can take home. Most pharmacies have information sheets on your prescription medicines. Some even offer large-print or Spanish versions.

Tell:

• Any concerns you have about using the medicine.

• Any concerns you have about staying with other parts of your treatment.

• If you are not taking your medicine as directed. For example, some people stop taking their medicine as soon as they feel better. Your doctor needs to know about any changes in your treatment plan. Do not let guilty feelings or embarrassment keep you from telling your doctor this important information.

Tips:

• When you pick up your medicine, ask your pharmacist any questions you might have about it. If you are in a hurry or would feel more comfortable, call the pharmacist later from home.

• Try to use one pharmacy for all your medicine needs. The next time you are there, take a few minutes to fill out a "profile" form listing all the medicines you take. (Bring the list found under "Medicine record list" in this document to help you.) This will help your pharmacist keep track of your medicines.

• Some pharmacies are open 24 hours a day. Look for any in your area, and keep their phone numbers handy, along with the number of your regular pharmacy.

• Some products (often called compliance aids) can help remind you to take your doses on time and keep track of the doses you take. These aids include check-off calendars, containers with sections for daily doses, and caps that beep when it is time to take a dose. Ask your pharmacist or doctor what is available.

• Friends or family members can also help you follow your treatment plan. For example, they could remind you to take a dose or double-check that you did take a dose. But remember: Your medicine was prescribed for you. Never share your prescription medicines with anyone.

Step 3. Watch for problems and get help in solving them. It’s important that you keep working with your health professionals while you are taking your medicine.

Ask:

• About the results of medical tests that show how the medicine is working. For example, if you are taking a drug for high blood pressure, what is your blood pressure reading now?

• If medicine is still needed.

Tell:

• Any problems you are having taking your medicine.

• About side effects or any new problems that may be related to the medicine.

• About any new medicines that another doctor gave you and any over-the-counter medicines that you started taking since your last doctor’s visit. Before you visit your doctor, make a list of all medicines that you take, using the "Medicine record list" in this document as a guideline, and bring it with you. Try to keep this list up to date. Telling which medicines you take is very important — especially if you have more than one doctor.

• How you are feeling since you started taking the medicine. Do you think it is helping?

Tips:

• A yearly medicine checkup is a good way to spot hidden problems. Schedule a time with your pharmacist or doctor to look at all the prescription and over-the-counter medicines you take. They can check for duplicate medicines and proper doses. They can also advise you on medicines that are no longer needed and tell you how to safely get rid of old medicines.

• A home health nurse or pharmacist can help you and your family solve medicine problems.

Health care providers list

Stay in touch with your health care professionals while taking your medicines. Keep these names and numbers near the phone in case you have problems or have questions. It’s also a good idea to give a copy to a friend or family member.

Doctor ___________________________________