PRIMETIME Doctors' orders on prescriptions often go unheeded
Cost, attitude are factors
By Kevin Freking
WASHINGTON -- Two of every five senior citizens don't follow their doctors' orders, sometimes because of cost, sometimes because they just don't want to.
The data from a new survey indicate that a prescription drug benefit that takes effect Jan. 1 will solve part of the problem by making medicines more affordable, researchers said. But they also said cost is only one factor in determining whether senior citizens do as their doctors recommend.
Many elderly patients just don't believe they need the medicine prescribed, or they don't take their medicine because of the side-effects involved.
"It's a problem that goes well beyond what the legislation can address because it goes to doctor-patient interaction," said Dana Gelb Safran, who directed a research team conducting the survey at the Health Institute at Tufts-New England Medical Center.
"Doctors and patients need to be talking about how patients can afford and tolerate the medications the physicians are prescribing," she said.
The Kaiser Family Foundation and the Commonwealth Fund also sponsored the survey, which was conducted by mail between July 15 and Oct. 7, 2003, among a random sample of 36,901 non-institutionalized Medicare patients. Nearly 18,000 responded. The survey has a margin of sampling error of plus or minus 1 percent.
The survey found that the multiple prescriptions many senior citizens are given make it difficult for them to follow a regimen. Of those who reported taking prescription drugs within the past year, 46 percent said they take more than five prescriptions.
About a quarter of those who responded to the survey reported forgoing prescription drugs because of cost. That problem has been well publicized, and it is part of the reason lawmakers approved a new prescription drug benefit under Medicare. The benefit is expected to save those senior citizens who have no coverage an estimated 53 percent on their prescription costs.
But a comparable number of senior citizens also declined to take their medicine because of nonfinancial considerations. The medicine made them feel worse, or they didn't think it was helping, or they felt they took too many medicines already, Safran said.
She said other studies, smaller in scope, indicate that doctors and patients aren't discussing these matters.