Living a healthy lifestyle of good nutrition, regular exercise, reducing stress and adequate sleep are all important to manage heart disease and other conditions. However, sometimes that isn’t enough and medications are needed.
For the past year I’ve been taking two medications for my heart condition (a beta blocker, bisoprolol, and a statin, rosouvastatin) religiously. Working in a heart clinic, I know this isn’t much. Some patients take up to 10 medications at multiple times per day. That scenario is becoming increasingly common as more and more people have multiple chronic diseases.
Recently I got a taste (poor choice of words?) of managing four medications with repeated dosing for a week. I had a severe throat infection that required IV antibiotics in the emergency room and I was also prescribed an oral antibiotic (metronidazole, two tablets twice per day). After two days of IV doses, another antibiotic, clindamycin, was given to me, this one at two tablets three times a day.
The first thing that strikes me is the names of these medications. It’s as if the more syllables the better. Who thinks up these names? They sound more at home in a Star Trek episode than in my mouth, right up there with the Klingons and Cardassians (no relation to the Kardashians — I think).
Right from the start this becomes a barrier to communication with your healthcare provider. When patients are asked what medications they’re taking, many say something like the small red pill or blue pill, as they can’t remember or pronounce the full names. In this case, carrying a list in your wallet or purse with the doses can be helpful.
Taking your medication as prescribed (what we call adherence) is extremely important to improving your health, whether that’s a short course of antibiotics or a lifelong prescription for blood pressure. For example, poor medication adherence is a key determinant to early hospital readmission after a heart attack.
Understanding is key
But it’s not always easy to remember to take your medications. And as the number of pills and complexity of the regimen increases, adherence becomes harder.
Understanding what the medication does and why it’s needed can help with patient adherence. For example, some patients taking a cholesterol lowering medication stop it every time their cholesterol values improve. As a result, their cholesterol goes back up. Talking to them, it became clear they thought the medications acted like an antibiotic and once the cholesterol was within target it would stay that way.
Sometimes we think a doctor or nurse can’t be wrong, but they’re human too.
It would be nice to think health professionals will tell us all we need to know about our medications, but that isn’t always the case. As patients we need to ask questions. Sometimes we think a doctor or nurse can’t be wrong, but they can be. They’re human too.
After the second dose of my IV antibiotics, the ER doctor gave me a prescription for an oral antibiotic. I looked at the prescription and asked what it was. When the doctor responded I told him I was allergic to that medication. He hadn’t asked about allergies and at first I just assumed it would be in my chart. It wasn’t. He also got my name wrong on the prescription.
Asking questions, getting reminders
As I was already taking an oral antibiotic prescribed the day before, I wanted to confirm that I had to take both. I know from talking to other patients that sometimes it’s not clear when you go into the hospital and are prescribed new medications if the new ones are replacements or in addition.
You can imagine that lying in bed following a heart attack your mind might not be the clearest. Some medications don’t work well together and taking multiple medications (called polypharmacy) can lead to adverse effects if this isn’t clarified.
This concern about adverse reactions from polypharmacy has led to a growing field of research into medication reconciliation, in which healthcare providers and organizations are looking at ways to reduce problems. One such program has pharmacists follow up patients at home to go over their medications.
Since I was only on these antibiotics for a week I didn’t find it too problematic. But it did make me reflect on the challenges I’ve seen patients have in managing their own medications. Fortunately there are a number of aids people can use such as pill boxes or having the pharmacy put your medications into bubble packs (although this can be pricey).
In this digital age, you can also upload a medication reminder app to your phone. Some may be effective but many are not and so you need to be vigilant to see if they are right for you.
Healthcare organizations and insurers are starting to use programs that support adherence. In the field of HIV, the use of automated text message reminders has proven to be of great value. We’ve built on this work and we will soon know the results of our pilot study of using text messages to improve adherence in heart patients.
For me, back to taking only my two medications, I use a low-tech strategy. I have them on my bathroom counter so that I see them when I brush my teeth in the morning and again at night. It’s not foolproof but it works 99% of the time.
- Get more healthy living tips to help you reduce your risk of heart disease and stroke.
Dr. Scott Lear is a leading researcher in the prevention and management of heart disease. He holds the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul’s Hospital in Vancouver, and he is a professor in the faculty of health sciences and the department of biomedical physiology and kinesiology at Simon Fraser University. Dr. Lear also lives with heart disease himself. Follow his blog at drscottlear.com.