Swimming upstream against the patient compliance odds - a personal journey
At eyeforpharma, we try to keep in mind that the patients we speak of so often in our articles arent some far removed third party theyre us our families, our loved ones. Im getting a big dose of that reality just now. Recently my family has been plagued with more than its fair share of health challenges.
As our parents age, my husband and I have struggled with a myriad of patient care issues in our quest to make their golden years comfortable ones. In the past year, Ive spent hours far too numerous to count holding up chairs, sofas, floors and posts in at least five different hospitals and more than 30 specialist doctors offices.
The struggle for quality of life and at times, simply life at all, quality or not has come with lots of thinking time for us. And my personal epiphany during this year or more from hell: patient compliance is such a monstrous and complex challenge, it may be insurmountable, especially as our loved ones age and their health problems multiply.
As my mother-in-law slipped deeper into the grasp of what we think was Parkinsons disease, her fierce penchant for privacy was her own worst enemy. She held her healthcare cards close to her chest and with the help of patient privacy laws, she could. She kept even her closest family members guessing at exactly what health problems she suffered. She took somewhere on the order of 12 to 15 prescription medicines a day, but only she knew exactly how many and exactly what conditions they were meant to treat.
As her cognitive skills waned, her ability to tell the pink pill from the blue one and the yellow one faded, too. She couldn't remember what she'd taken when or why. Helping her to remain compliant with her prescription therapies (some of them hidden entirely from our view) was a battle, that as hard as we tried, wed already lost. Was she taking too much of the green one, not enough of the blue one? Well never know. Would it have mattered? Its a question well have to keep asking ourselves for the rest of time.
But in our world, theres unaware, unintentional lack of compliance and then theres pure stubborn. Pure stubborn (as much as I love him) would be my father-in-law. At some point, many years back now and despite a long-running struggle against heart disease, he decided that he knew more than the doctors and that he was taking far too many pills and surely that blood pressure medication theyd given him was unnecessary.
Today he faces dialysis three days each week to replace the work his kidneys once did before high blood pressure knocked them completely out of commission. Even now, faced with the stark reality of total kidney failure, he ignores the doctors pleas to stick to a strict renal diet. At nearly 80, he feels hes earned the right to eat whatever he wants no matter that the high potassium and phosphorous of his favorite foods are further destroying his heart and circulatory system. The dialysis machines suck it out every other day he reassures me.
Is more information the answer, as Lynn Fox, information director of the UK"s MS Trust, urges in todays feature (see What have you given your patients lately?)? For MS patients mostly diagnosed in their 20s and 30s with few other health problems and a hope for many years ahead of them yet to live, Im sure shes right. But what is it they say about teaching old dogs new tricks? Not likely.
Cognitive challenges, rapidly multiplying conditions, defiancemaybe Im just dog tired right now, but Im not sure the battles of compliance with aging patients are ones that even the most dedicated and well intentioned pharma company or healthcare professional can tackle. I certainly know theyve proved too much for even the most loving and attentive of families to overcome.
Are we just kidding ourselves with older patients?