Skipping Drugs May Signal Distrust of Doctor

Lack of Trust in Doctor Leads to Not Taking Medication

From the WebMD Archives

Aug. 8, 2005 -- Patients who fail to take their medication on schedule may not only be worried about costs. They may also be signaling a basic distrust of their doctor.

Skipping medications or refusing to stick with a regular routine also may be a red flag indicating depression. Such are the findings of a recent study conducted by the VA Ann Arbor Healthcare Center and the University of Michigan.

Past research has attributed patients' erratic medication schedules primarily to the cost of drugs.

A study done in 2004 by John Piette, PhD, researcher of the new study, indicated financial reasons were behind one in six chronically ill patients' decision to alter their drug dose. Although that clearly remains a factor, drug costs are only one part of the picture, according to results of the new study.

Surprising Glimpse

The study involved 912 patients with diabetes. Forty-one percent used insulin to help keep their blood sugar in check. For the majority, annual household income was less than $25,000.

Results provided a surprising glimpse at how a number of factors -- cost, trust, income, and mental health -- all work together to influence how diligent chronically ill patients will be in taking their medication on a regular basis.

Primary focus was on patients with monthly drug costs exceeding $100.

Almost 30% of those admitting to some level of distrust in their doctors said they skipped their medication due to cost. A fairly small percentage -- 11% -- of those professing trust in their doctor missed a dose, even though drug costs were the same.

Among those with incomes under $10,000, cost affected adherence to drugs only among those with low physician trust.

Patients Speak Up

It's generally known that skipping a drug dose may have dire consequences -- especially in cases where a chronic disease such as diabetes is present. People with diabetes who fail to take their medication when they're supposed to run an increased risk of heart attacks, strokes, blindness, amputation, and kidney failure.

According to Piette, the message is clear.

Doctors need to recognize -- and act on -- the multiple benefits of reaching out to establish trust with their patients, striving to form a strong therapeutic bond, and asking patients directly how drug costs are affecting them.

Patients bear their own responsibility.

"It's important to be open and honest regarding worries about how you're going to pay for your medicine as well as other things such as side effects and lifestyle issues that might prevent you from taking your medicines. Also, your doctor needs to know if you're experiencing any depression-like symptoms such as prolonged sadness or sleep and appetite changes," he says in a news release.

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SOURCES: Piette, J. Archives of Internal Medicine, Aug. 22, 2005: vol 165. News release, Patients and RX Costs. News release, University of Michigan Health System.
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