Wednesday, January 7, 2015

Presumption of illness/noncompliance

A recent experience underscored the illness-driven nature of some parts of our health care system. Some necessary background: several years ago my cardiologist put me on lipitor. I had an adverse reaction (muscle pain, fatigue) and after some trial and error began using a combination of crestor (a statin) twice a week and zetia every day. It works great. My numbers are dandy. I've been hypertensive since I was 23 years old, when I was skinny. It's just how it is. Been on medication a long time. Take a beta blocker for tachycardia and bp. Had ventricular arrhythmias which resulted in two ablations one of which resulted in a puncture, CPR, cardiac arrests and the big drama and emergency open heart surgery to repair the puncture, so I'm followed fairly closely. Since I also have heart spasms, I take a calcium channel blocker for that. When the CCB was introduced, that gave me a total of four medications that work on blood pressure that I'm taking. I also exercise almost every day-rowing machine, walking, or biking for 30-45 mins. I noticed that my resting pulse was really low (57-60) and bp was in the 103/62 range (with all the meds). So I talked to my cardiologist and asked if I could cut back on some of the meds since neither my pulse nor my bp needs to be that low and I'd prefer my body not become resistant to the meds. At some point I may need to go up on the meds. He agreed and we gradually reduced the metoprolol to 50 mgs from 100 and the lisinopril from 20 to 10 mg. Of course, I've been checking my bp and pulse and it's fine.

Enter the pharmacy management part of my health insurance. I got one letter, notifying me that they had noticed I wasn't taking as much of a particular medication as they expected. The letter went on to say that there were resources available to me, etc. etc. etc. It was all very caring and very nice. Well, I didn't do anything at that point. After getting a couple of more letters, I noticed that they listed five reasons why people don't take their medication as prescribed:

a. they forget
b. side effects
c. they can't afford the medication
d. they don't see the benefits
e. they are confused about how to take...

I was prescribed to take the statin twice a week, not every day, but I guess they didn't see that. But the reduction in dosage of the others was with medical advice and was the result of my losing some weight and increasing my exercise.

It's admirable that pharmaceutical management teams are paying attention and reaching out to help people who need assistance with purchasing or taking medications. BUT, there is something wrong when that same team never considers that the patient could actually be improving and needing less medication and that the change was done in conjuction with a physician. I find that just disturbing. It is distressing that a positive reason for the change did not seem to have been considered.

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