Why Patients Don\'t Adhere To Cholesterol, Osteoporosis Medications

Two new studies by Kaiser Permanente have delved into the reasons patients do not adhere to medications to control cholesterol and stem the progression of osteoporosis.

The studies included interviews with nearly 100 Kaiser enrollees who were prescribed statins to control their cholesterol but did not fill their prescriptions, and the examination of the electronic medical records of more than 8,400 Kaiser Permanente enrollees over the age of 55 who were prescribed bisphosphonates to address their osteoporosis.

Lack of adherence to prescription drug regimens is a serious problem in the U.S. According to data from the Commonwealth Fund, 48 million Americans didn't fill a prescription in 2010, although much of that was associated with cost rather than other reasons. Another study by the Pharmaceutical Research and Manufacturers of America suggested non-adherence to medications for treating chronic conditions was as high as 20%, even among those with adequate insurance.

In the U.S., high cholesterol and osteoporosis or osteopenia are considered chronic conditions. 

According to the Centers for Disease Control and Prevention, about 71 million Americans, or nearly one-quarter of the population, has high levels of cholesterol, a precursor to developing heart disease or heart attacks. Less than one-third of those with the condition have their cholesterol levels under control.

Some 40 million Americans, mostly women, have osteoporosis, or osteopenia, a precursor to the condition.

In the case of the statin prescriptions, 63% of those interviewed said they didn't fill their prescriptions because they had general concerns about taking the medicine. A similar percentage wanted to try lifestyle modifications first to control their cholesterol. And 53% said they were concerned about the side effects of the medicine.

"Our study found that patients' reasons for primary non-adherence are varied, which suggests that individually tailored

nterventions could be helpful in increasing medication adherence," said study lead author Teresa Harrison of Kaiser's Department of Research & Evaluation in Pasadena. “Understanding why some patients choose not to fill these prescriptions will help us create strategies to increase medication adherence and, hopefully, help more

atients mitigate the health risks associated with high cholesterol.”

Researchers also found that one-third of the interviewees had issues with health literacy.

In the osteoporosis survey, nearly 30% of patients did not fill their prescriptions. Older patients and those who had utilized a hospital emergency room within the past year were more likely not to pick up their medications.

“Healthcare providers must do a better job of identifying barriers and developing

nterventions that address the individual patient's needs and concerns at the time the prescription is ordered,” said Kristi Reynolds, a Kaiser research scientist and the study's lead author.

Neither study made specific recommendations.

The statin study was recently published in the Journal of Managed Care. The osteoporosis study was published in the journal Osteoporosis International.

Statin manufacturer Merck Sharp & Dohme Corp. partly financed the statin study. Amgen, Inc., which manufactures several osteoporosis-related drugs, partly financed the study involving the osteoporosis patients.