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Patients’ unfilled prescriptions

Let me ask you a simple question. When you get an antibiotic from your doctor, do you always take the pills the right way?

If it says “three times a day for 10 days,” do you ever miss a dose? And if you feel better in a week, do you take the full 10 days?

Uh-huh! Just what I thought. You probably weren’t 100 percent on task 100 percent of the time.

We docs have known that for a long time. But a new article published in the British Medical Journal shows something I never knew: One out of three people never even get the prescription filled.

I found that to be shocking. I knew about the “don’t finish the pills” thing because I, too, have done that with antibiotics (yes, I’m only human). But the unfilled prescription thing is something that never crossed my mind.

Now, the study found that most folks did fill their antibiotic prescription, even if they didn’t take all the pills all the time. But when it came to cholesterol medications, blood-pressure pills, antidepressants and skin creams, forget it.

Those who knew their primary care provider – doctor, nurse practitioner, physician assistant – were more likely to get the prescription filled. Those who went to the ER or Urgent Care were less likely to do so.

Why? I suspect trust fits in here. Older, more educated or more financially secure patients were more likely to get those medications and use them. Money and education are always great determiners of health outcomes.

Now hold this in your head while I jump to another BMJ study that looked at resistant hypertension, blood pressure we docs can’t seem to control. This is the kind where people are on three or four blood-pressure medications.

The study took 200 people at a specialty hypertension clinic – the type of clinic I send my patients to when their blood pressure seems too high for too long. They found that a whopping one in four were not taking their pills the right way.

That’s right, through pill-counting technology (pill bottles that kept track of when they were opened) and urine tests, they found that 25 percent of patients weren’t taking their medications correctly. That’s a real eye-opener, isn’t it? Especially if you consider that these patients were probably very motivated to get their blood pressure under control.

Why weren’t they taking their meds right? Researchers thought perhaps it was fear of treatment (the drugs might hurt me), lack of understanding the consequences (if you don’t take these pills, you might get a stroke) and just not paying attention.

I have a theory: I think we medical providers have done a poor job of health education. We prescribe a pill and say, “Thank you very much. Do you have any questions?” Then, too many patients who really do have questions are afraid of seeming “dumb” if they ask them. Am I right or am I right?

Educated people aren’t afraid to ask questions. People who make more money often ask questions, too. They’re used to it.

Unfortunately, we don’t have a health care system that allows us to make sure every time we write a prescription there is a follow-up to know it is understood and taken properly.

Dr. Zorba Paster hosts a radio program at 3 p.m. Saturdays on WBFO-FM 88.7; email him at

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