More medications for chronic conditions may not help, study shows
Reported May 07, 2009
Increasing the pill intake for patients with chronic medical conditions doesn’t improve their health-related quality of life and, in fact, can make them worse, a new study shows.
Researchers at Los Angeles Biomedical Research Institute near Torrance say there comes a point where pills actually impede, rather than improve, one’s health – at least for dialysis patients who took an average of 19 pills a day for various ailments.
“From a quality-of-life perspective, this is something physicians often don’t pay attention to,” said Dr. Rajinish Mehrotra, one of the authors of the study, which appeared this week in the Clinical Journal of the American Society of Nephrology.
One of the 233 dialysis patients they studied took an astonishing 80 pills a day. About a quarter of the patients took 26 or more pills a day, with the average being 19, the researchers said.
The two biggest consequences of this high pill burden are side effects, which can range from gastrointestinal discomfort to severe nausea, and drug interactions. Pharmacists don’t always communicate with doctors about what drugs their patients are taking, which can cause serious health problems, the researchers say.
About two-thirds of the patients studied didn’t take their pills as prescribed, a tendency that increased as the number of pills increased, the study showed.
“Patients can only take so much in one day,” Mehrotra said. “It becomes just too hard to keep track of.”
The average person over 65 takes slightly more than four prescription medications at once, plus two over-the-counter medications, according to the National Institute on Aging.
Torrance resident Grace Martin, who is in her 70s, said she can barely keep track of the eight prescribed medications she takes daily, not counting vitamins and over-the-counter painkillers such as aspirin. She suffers from high blood pressure, high cholesterol and other conditions.
“I guess that’s part of getting old,” said Martin, who was not part of the study. “Sometimes I feel like all I do is take pills and visit the doctor.”
Patients who participated in the study were all on dialysis because their kidneys no longer functioned properly, often a result of diabetes or high blood pressure.
About half of their medications were so-called phosphate binders, which reduce the absorption of phosphate into the blood. The other drugs taken by the patients were to control blood pressure and other health problems.
The researchers found that increasing phosphate binders does not help in lowering phosphorus levels in the patients’ blood stream, likely because they aren’t taking their medication, researchers say.
Dialysis patients in particular take a high number of drugs, typically three or four tablets just to control phosphate with each meal. Medication can cost upward of $1,000 for a three-month supply, physicians say.
If phosphate levels remain high, there’s only so much doctors say they can do to control a patient’s behavior outside the hospital. That includes diet and taking medication properly.
“I tell them you have two choices,” said Dr. Vinh Cam, a nephrologist at Torrance Memorial Medical Center. “You can either take your pills, or I’m going to have to increase the medication. You feel powerless and hopeless sometimes.”
The problem of pill burden is likely to become more acute as people age, and as more people are diagnosed with diabetes and high blood pressure – two of the most common chronic health conditions, researchers say.
Mehrotra said physicians should be encouraged to try other interventions, including dietary modification for patients or by making adjustments to their dialysis regime.
“These are a group of patients who are very sick, and that does require a lot of interventions,” Mehrotra said. “But they can still have a very productive social and professional life.”
