What You Need to Know About Taking Your Heart Medications

Podcast Transcript

Announcer:
Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Mike Militello:
My name is Mike Militello, I'm one of the cardiology pharmacists here at the Cleveland Clinic. And today we're going to talk about why patients may not take their medications. Sometimes we refer to that as noncompliance. What's important about noncompliance is that approximately 125,000 patients per year die relating to the improper use of medications. We call this noncompliance of medications.

Mike Militello:
The other issues that occur with noncompliance is the fact that there is increased hospitalizations. Patients may not get the full benefit of medications if they're not using it correctly. Some patients may take medications because of costs, maybe less often or less times per week. There are lots of other issues though related to why patients don't take their medications. Some of the things that we know of and why patients don't take medications is they don't understand medications.

Mike Militello:
It's very important to talk to your healthcare providers, your pharmacists, your physicians, the NPs, everyone who's involved with your care about what medications are used for. The more patients understand, the more people understand why they're taking their medications and understanding the benefits of those medications, it's a lot easier for them to want to take them. We do know though that it gets somewhat complicated as we have a large number of medications. So that's another reason why patients sometimes are less likely to take medications.

Mike Militello:
They have so many medications, or they have side effects that they're afraid of, or they have side effects that they're not discussing with their healthcare providers. A lot of the things that we talk about in terms of why patients don't take medications, we can alleviate some of those by having discussions, making sure that people understand why the medications are important, what the major side effects are, when it's important to discuss side effects with your healthcare provider. It's important to know how often to take medications, how many times per day.

Mike Militello:
And that's another reason why we want to go through medications or have a good list of medications when you see your healthcare providers, because we'd like to know which ones are still necessary, which ones could we get rid of, which ones are causing more problems, ones that we could potentially switch to another one that has less side effects. It's really important as we have medications and more medications added to people's regimens to have a discussion with your providers about, are these medications necessary? How long will I be on these medications? Do these medications need to be long-term?

Mike Militello:
Other reasons people don't take medications correctly include depression related to their disease state. There's a lot of changes when people have certain diseases. For instance, if a patient has a heart attack, they have been many times relatively healthy up until that time, they may go to have a procedure, having a stent placed.

Mike Militello:
After the stent is place and having a heart attack, most patients if they're on no medications will end up being on at least three, if not five medications on discharge from the hospital. Many of those medications are very important to take. Otherwise, you could be back in the hospital or potentially not do well because of not taking certain medications and the stent could close. We make sure that we discuss these things prior to patients leaving the hospital.

Mike Militello:
What can we do about improving patients taking medications? One, having in-depth discussions with patients about their medications? Why are they useful? What benefits will you see from these medications? Discuss costs associated with the medications. There might be alternatives for patients. Making sure that understanding, what do I do if I forget a medication or I skip a dose? What do I need to do next? How often do I take these? And having a good list of medications when you go to your providers to make sure that we have a good running list of these medications.

Mike Militello:
What other things can we do? Well, a lot of times, some of the issues occur are that patients can't see well. They can't see their prescription bottles. They don't hear well. Having an advocate with you going to your appointments, if it's a spouse, or a son or a daughter, or a parent, or somebody that's a close friend. Sometimes it's helpful for having more than one person hear what's being said so that you can have a discussion and understand about the medications. There are lots of things also that we can do to help.

Mike Militello:
Some of the tech savvy people like to use their smartphones. There are multiple applications that you can look at. I do use an application myself that helps me with my medications, and it reminds me every day. What that really has done is... There's so many apps that you can use, and it's not necessarily the app. It's actually getting into a routine of taking your medications. I have a routine that it's every morning I get up, I take my medication, and then I take one before I go to bed. And that routine helps me not forget to take my medications. It's always the same thing.

Mike Militello:
But using the reminder that I use with the app helped me get into that routine. There are a lot of apps that out there that are applicable. Some are free. Some cost money. What's really important is if you want to... All apps aren't created equal. There are lots that are great. There are some that contain reminders for your refills. There are reminders for when to take the medications, when your next doctor's appointment is, putting a list in. There's lots of different ones that you can choose.

Mike Militello:
Some people like to be old school and they just set a timer for throughout the day and say, "Okay, when the timer goes up, I know that's what I need to take my medication." And that's great as well, whatever works best for each individual person. Each time or each patient's going to be a little bit different in how they utilize the technology to improve their assurance of taking their medications correctly. Other things that we use, which are very old school that I've recently bought for my mom because hers were so old, are medication boxes.

Mike Militello:
There's medication boxes for people who are taking twice a day medications, once a day medications, and people who are taking medications multiple times per day. Every Sunday, we fill the box up and then she's ready for the week. I think that a lot of people use that and make sure that they're going through their medications, filling their boxes. And that actually helps compliance.

Mike Militello:
When they realize that in the morning they get up, they open their box, and then maybe... Or maybe they forget to do that. In a couple hours, say, "Oh my gosh! I forgot to take my meds," and so they go back to their box. And then having that discussion of when I can take a drug late, or should I skip the dose is something that you need to discuss with your providers. Other things that are helpful too include many pharmacies have refill assistance programs where you can sign up with your pharmacy that you normally go to, and those pharmacies can send you reminders of when medications need to be refilled. You can set notifications for what time you should have them.

Mike Militello:
You want a week before, three days before. Most of us recommend to have at least a week before medications when you're needing to refill your medications. Also, working with your pharmacy to make sure that you can try to get most of your medications refilled at the same time. Decreasing the number of times going to the pharmacy or having to get your medications actually helps people become more compliant.

Mike Militello:
Also, making sure that in situations where you can get a multiple month supply, like a 90 day or three-month supply, is very helpful too in making sure that you have medications on hand. Lastly, the other ways that can be helpful, especially in terms of costs of medications, if medications are too costly, one, talking with your providers to see if there are alternatives that are generic, or if you're able to use a medication that's less expensive.

Mike Militello:
There are other ways such as with brand name medications, going through the voucher programs of the individual pharmaceutical companies. They have voucher programs. Many people have heard of coupon or assistance programs, like GoodRx, which are helpful as well. And also sometimes there are vouchers within your healthcare system that can help with medications. Overall, in review, medications we know there's not... We know that the difficulties in taking medications is very common. About 50% of patients don't take their medications correctly.

Mike Militello:
We do know that there are lots of things that can help us, reminder pill boxes, reminder applications, understanding your medications better, once a day medications when possible. All those things are useful in improving the compliance of medications. Thank you.

Announcer:
Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/loveyourheartpodcast.