Patient Compliance and Solutions

Patient Compliance 

Many stroke survivors are patients for the rest of their lives. They remain under a doctor’s care, taking medicine and living with dietary, exercise and stress management prescriptions. But not following the doctor’s guidance is a costly and growing problem.

If you aren’t following doctors’ orders — and that’s about half of you — use this list to start tackling the problem.

Internal Barriers

Denial

For many people, taking a prescription reminds them that they’re sick. You might take your dose one day and skip the next to see if anything happens. Although you might not feel appreciably better or worse taking blood pressure medication, the long-term consequences can be catastrophic.

Stubborn refusal

Some patients just won’t cooperate. They may refuse to take their meds because of unpleasant side effects. Others expect immediate results and quit when they don’t see them. If they doubt their treatment plan is effective, they’re likely to resist.

Cognitive deficits

Short-term memory loss can make maintaining a simple dosing schedule challenging. Some patients have difficulty doing the complicated sequencing that multiple prescriptions require. Dementia or memory loss are especially serious for people with high blood pressure or diabetes, because the conditions require constant monitoring.

Lack of knowledge

Many survivors leave the hospital not understanding how the stroke happened or the therapeutic strategy or its goals. Some don’t understand the underlying condition that may have caused the stroke. They’re unprepared for the amount and complexity of information that comes with a new diagnosis. The Internet contains a staggering amount of health information, but that doesn't mean it's accurate. Always be concerned about the source of information, and never act on anything until you've discussed it with your physician. Not all websites are created equal. Timely information from reputable sources such as:

• www.stroke.org, 

• www.fda.gov,

• www.diabetes.org, and

• www.nih.gov

can provide solid information.

Life gets busy and other priorities get in the way

It seems like taking a pill every day would be easy, but sometimes what is easy to do is easy not to do. At first, your medication may be the highest priority, but eventually, other priorities pop up and demand attention.

External Challenges

Challenge Not enough time with the doctor.

Physicians’ time is often at a premium. That can work against patient education. Patients who don’t understand their treatment or its rationale have a hard time following directions.

•  Go to your appointment with written questions.

• Find out as much as you can about your condition and write down questions to ask your doctor.

• Keep a pad where you store your medicine so you’ll have a central place for jotting down questions.

• Bring a loved one to take notes.

• Record the doctor's orders so you can review them.

Challenge: Too many medications and complicated lifestyle prescriptions to eat better, move more and stress less.

Many stroke survivors take multiple medications. And the more complicated the drug or lifestyle prescription, the less likely a patient will follow it.

•  Create a medication map — a schedule that covers the whole day. It plots timing, dose and special instructions, like nutritional support. It organizes all your medication in one place so you see at a glance what, when and how much you should take. A dosing calendar is also helpful because you can check off the date after taking your medicine.

• Schedule a “brown bag” session with your doctor or pharmacist.

• Put all your prescription and non-prescription medications in a bag and take them to your doctor’s office or pharmacy. They may find overlapping or duplicate prescriptions from different doctors.
  
  
• Download our medication tracker (PDF)

Challenge: Lots of doctors 

Patients may have several doctors and get conflicting advice and requirements. They may make uninformed choices or give up.

• Appoint a healthcare gatekeeper. Find a doctor you trust and can ask to be the ultimate arbiter of your treatment. This way you won’t have to make uninformed decisions about conflicting advice or therapies.

• Ask your pharmacist to review all your medications for problem interactions and then ask your primary care physician to resolve the problem.

Challenge: Cost 

Drugs are expensive. Even patients with good insurance may find that their policy is deficient in prescription coverage.

•  Comparison shop.

• Investigate the prices charged for your prescriptions at several pharmacies. Also check prices at online pharmacies.

• Investigate patient assistance programs. Most drug companies have special programs called patient assistance programs that discount certain drugs.

• Do a little Internet research and talk to you doctor for advice.

• Ask your doctor about cheaper alternatives. Before you leave your doctor’s office, find out if your prescription is covered by your insurance plan. If it isn’t, they may be able to switch you to a drug that is.

Challenge: Physical limitations

• Have medications delivered or picked up for you.

• Online ordering essentially brings the pharmacy to your door. (Most brick-and-mortar pharmacies have Internet ordering sites, so you don’t have to start with a new company.)

• If you can’t get on the Internet, ask a trusted friend or relative to place the order for you or find out if your physician can do it for you.

• You may also be able to find a local pharmacy or a mail order pharmacy that takes phone orders and delivers.