One pill less can cause a stroke and death

How can we ensure improved compliance with therapeutic recommendations – this was the topic discussed by the panellists during the debate on shared responsibility in the treatment of chronic lifestyle diseases.

Patients' failure to comply with therapeutic recommendations poses significant, but avoidable, challenges for the health care system. Apart from the significant death toll, there are other consequences, ranging from financial losses to an excessive burden on the health care system.

‘Hypertension is a perfect condition to analyse the partnership between patient and doctor,” says Professor Andrzej Tykarski, hypertensiologist. “We talk more and more about adherence. This term refers to adherence to pharmacological and non-pharmacological recommendations. There is also the concept of ‘persistence’, in other words, whether the patient persists with the treatment or quits the therapy. We should also talk more about ‘concordance’, that is whether the patient accepts treatment as part of the therapeutic team, which includes a doctor, a nurse and other people.”

Simplify recommendations

Patients, especially elderly people, take a lot of pills and often confuse the times they should take them. Sometimes they forget to take a particular medicine, sometimes they cannot afford to buy more expensive drugs. This is why, according to experts, it is necessary to favour multicomponent drugs as much as possible to simplify treatment for the patient.

Prof Tykarski reminded that hypertension is a disease that causes no pain for many years, so it does not motivate the patient to comply with therapeutic recommendations. However, it is crucial to take medication when suffering from hypertension. If a patient takes more than 80% of the prescribed medication, they are considered fully cooperative. If they take 50-80% of the doses – they are partially non-adherent. There are also patients who take medication even less frequently.

“Failure to comply with therapeutic recommendations is one of the main reasons for the lack of control of blood pressure in our patients. This control is about 26% in Poland, and is an estimate from ten years ago. It is colloquially said that if blood pressure is not under control, we deal with resistant hypertension, and we also have a resistant doctor who does not provide good enough treatment, and of course – a resistant patient who does not follow the recommendations,” explained Professor Tykarski.

Creating motivation

Patients lack motivation because they do not understand the consequences of having strokes, heart attacks and death during the course of this disease. In the past, before combination drugs became available, the treatment was quite complicated, patients did not understand how to take the drugs with such a frequent dosage and did not accept this intensive therapy. Another reason is side effects or lower quality of life at the beginning of therapy.

Prof Tykarski admitted that the availability of medication and the cost of treatment for patients has improved.

“The Minister of Health's decision from July last year made combination drugs first-line treatment drugs. Previously they were substitute drugs,” the panellists said.

According to Professor Marcin Czech, head of the Department of Pharmacoeconomics at the Institute of Mother and Child, failure to comply with medical recommendations and poor partnership between the patient and doctor have negative consequences for all participants in the system, the patient – exposed to a lack of control of blood pressure and the resulting complications, doctors who fail to provide effective treatment, and the payer who spends money ineffectively.

“The economic consequences of failing to comply with medication are very serious. The consequence of non-compliance appears. The drugs are not effective, because drugs that are not taken do not work. This phenomenon is observed in half of the patients with type 2 diabetes or hypertension, where we can avoid serious problems with a low-cost treatment,” said Professor Marcin Czech.

He also reminded that the economic consequences of the lack of partnership amount to as much as EUR 125 billion on a European scale – the costs of treating complications, which include visits to further specialists, costly hospitalisation, treatment in intensive care units and inability to work.

“Often people after a stroke do not return to work simply because they have not swallowed that one pill,” noted Professor Czech.

Adam Grabowicz of IQVIA Poland cited research stating that only 60% of patients with type 2 diabetes start treatment and more than 70% of patients with hypercholesterolaemia do not start any treatment.

“These statistics are very worrying. I am convinced that doctors prescribe treatment, but patients, for various reasons, do not adhere to the recommendations,” stated Adam Grabowicz.

Changes for the better

One thing is certain – the results of treatment are the joint responsibility of the doctor, the patient and the system, which should facilitate proper treatment. Systemic changes can and should be introduced as soon as possible to help doctors and patients.

There are clear benefits from improving adherence to treatment, both for patients and the health care system. This improvement should become a priority for policy makers looking to strengthen the resilience of health care systems, especially given the current socio-demographic trends.