Patient compliance: The ‘missing link’

Despite all the medical breakthroughs yielding new drugs that are more effective and associated with less side-effects, effective control of cardiovascular diseases appears to be an elusive dream.

"No drug can ever be effective unless they are taken religiously," says Dr. Gregorio Patacsil Jr., president of the Philippine Society of Hypertension. "It may be the ‘missing link’ why some medical problems are not adequately controlled."

Patacsil bewails the common belief many patients have that taking drugs continuously will lead to drug tolerance, making the patient no longer responsive or sensitive to the medication he is taking.

"This is a myth resulting in the patient’s poor compliance in taking medications he should be taking continuously,’’ explains Patacsil.

Dr. Rebecca Lorenzo-Castillo, vice chairman of the Department of Medicine of the Manila Adventist Medical Center, emphasizes that adherence to a healthy lifestyle is essential in addition to the prescribed drugs.

"Lifestyle changes are the mainstay in the prevention and treatment of many common medical problems. From heart diseases to cancers, these lifestyle diseases can be significantly avoided, and if they are already present, the patient has a better chance of surviving them, hopefully licking them for good, with a healthy lifestyle change," says Castillo.

Castillo adds that when doctors prescribe drugs, they are not meant to be a substitute for a lifestyle change. The medicines are given on top of a healthy lifestyle prescription. The success of treatment depends on a religious adherence to both the lifestyle change and intake of medicine.

Castillo cites an example: "It does not serve one well if one indulges in a high-cholesterol diet because anyway, ‘I’m taking my cholesterol-lowering drugs religiously.’ This is a travesty of a rational medical treatment."

No drug, too, can ever be a substitute for a regular exercise. "Being too busy for exercise" is no longer an acceptable excuse for the health-conscious person in this millennium. Although it’s not the ideal way to do it, it may be done in 10-minute installments three times daily. "This is much better than no exercise at all," Castillo advises.

For the doctor’s prescription of a lifestyle change and medicines to be effective, the patient’s compliance is essential and many agree that this is the "missing link" why many chronic diseases which require life-long treatment remain uncontrolled. "A one-month exercise and diet program which is not sustained is futile," says Patacsil. He adds that poor compliance in taking anti-hypertensive drugs and cholesterol-lowering medications is a key factor why many still suffer from heart attacks and strokes, although the patients "take their medicines once in a while" or "on-and-off."

Castillo says that a doctor’s great frustration is not being able to achieve the optimal effects of medicines due to poor patient compliance. One example is in the area of cholesterol-lowering with statins. Tens of thousands of deaths each year may be prevented with the use of the class of cholesterol-lowering drugs called statins.

The 20,000-patient Heart Protection Study (HPS) published in the Lancet shows strong evidence that simvastatin, taken religiously for several years, cuts the risks of heart attacks and strokes in the high-risk population, particularly diabetics. The benefit extends to the elderly and to women, findings which have not been shown in previous clinical trials.

Simvastatin is probably the most scientifically documented statin in the market and, together with other statins, it is expected to revolutionize the way doctors aim to prevent heart attacks and strokes in high-risk patients. But the problem of high cost of statins resulting in unsustained patient compliance is again a big problem to hurdle. The introduction of a new brand (Vidastat) by Therapharma at an affordable price is a big boost that is expected to enhance long-term compliance.

The high price of statins may be a major factor discouraging their long-term use. But price of medicine is relative. It may seem expensive to take any of these statins, but if it can prevent heart attacks and strokes, minimize costs of hospitalization and doctor visits and maintain one’s productivity or earning potential instead of ending up a cardiac cripple, the cost of these drugs may turn out cheap in the long run.