In a time of unprecedented economic challenges and sweeping healthcare reform, the role of women in managing chronic disease becomes increasingly critical to the overall health and well being of the family. Often engaged with the needs of aging parents while simultaneously responsible for the health of children and spouses, many women find themselves making important decisions about which illness and family members require medicines the most, and how best to ration prescription medicines with so many competing needs. Not surprisingly, adherence-the commitment to starting and continuing a medication as prescribed by a physician-is an onerous goal. An alarming one in two people fail to take their medicines as prescribed. Three out of four people don’t keep follow-up appointments with their doctors. And 50 percent of people suffering from a chronic illness stop taking their medicine in the first year of being diagnosed. Guilty as charged! While I am committed to taking care of myself and being healthy for my family, I often struggle and ask myself: Do I really need to take my diabetes medication when I don’t see or feel any symptoms and I actually feel fine?
Pharmaceutical companies spend significant dollars encouraging the uptake of new and not so new medicines and occasionally spend even more on encouraging patients to stay on their medicines in order to effectively manage chronic diseases and maintain a healthy life. These programs often focus on a few traditional issues associated with adherence to medicines: cost, forgetfulness, and the management of side effects. While these are fundamental barriers to adherence (I certainly fall in the forgetfulness category), there are several other important barriers that get in the way and should be addressed in any adherence program:
- Some people may not be ready to fully accept their diagnosis and are hesitant to make changes needed to properly manage their condition
- Low health literacy causes individuals to struggle with understanding health and medical information which often leads to trouble making good decisions about their health
- Lack of communication between patients and their health care providers and poor communication due to language barriers can increase difficulties in understanding conditions and treatments
- Cultural beliefs, which may differ among groups, can affect how people manage their chronic condition, such as how they view prescription medicines or health care providers. Some cultures may mistrust their health care provider about their diagnosis or the effect of a medicine; while others may hold doctors in such high esteem that they hesitate to ask any questions even when there is confusion or lack of understanding about how to take certain medications.
We know from a multitude of research and data that women play a central role for themselves and others in dealing with diagnosis, deciphering health information in a meaningful way, communicating with physicians and other healthcare providers, and managing the cultural beliefs of the family especially as they pertain to health and illness. As pharmaceutical companies continue to engage patients with more creative and motivational programs that focus on sticking to the plan, addressing the role that women play in influencing behavior around these barriers must take center stage. The greater role women play in the development and implementation of adherence programs, the more likely they will stick to the plan for themselves and be empowered to assist family members in making better and longer lasting medication choices over their lifetime.
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