NEW YORK (Reuters Health) - A significant portion of people - perhaps as many as one in five - don't take drugs a doctor has prescribed because they can't pay for them, according to a new survey of people visiting an emergency room.
"I think this is a wake-up call," study author Dr. Karin Rhodes of the University of Pennsylvania told Reuters Health.
Among a group of more than 1500 people who volunteered to complete a questionnaire, more than 20 percent said they had previously not taken a prescribed drug on account of the price tag.
It's an issue that many doctors aren't aware of, noted Rhodes, and the system needs to address it. "Patients need to be asked 'can you afford your medications?' and they should get help to pay for them."
A number of studies have shown that people with chronic health problems, including high blood pressure, diabetes and heart disease, commonly fail to take their medications as prescribed.
Other reports have shown similar rates of so-called "nonadherence," although the actual estimate tends to vary depending on the exact questions researchers ask, according to Dr. Jae Kennedy of Washington State University, who did not participate in the current project.
One recent study found that 22 percent of prescriptions written for 75,000 Massachusetts patients were never filled. And in another, people were less likely to fill "dispense as written" prescriptions (See Reuters Health report, March 25, 2011).
Some people go to the trouble of filling the prescription, but never pick it up. Looking at information collected from 5 million Americans over 6 months, a study late last year showed that just over 3 percent never retrieve their prescriptions from the pharmacy, and were more likely to abandon expensive medications.
During the current study, 21 percent of the 1506 participants said they had previously not taken medications because of money concerns. Another 5 percent said they were worried they might not be able to pay for drugs.
The researchers, who published their results in the journal Academic Emergency Medicine, considered both groups to be "at risk" of nonadherence with future prescriptions.
Looking at the responses to other questions on the survey, Rhodes and her team found that people were more likely to be at risk of nonadherence if they had money issues - for instance, they worried about money, didn't have enough food, reported housing problems, and had inadequate health insurance. But they were also more likely to be at risk of nonadherence if they smoked, used illegal drugs, or experienced domestic violence, as either the victim or perpetrator.
"I think (nonadherence) goes along with people who have difficult, disorganized lives," said Rhodes.
Nonadherence has consequences, she added - one problem, if left untreated, will create others, such as when untreated high blood pressure hurts the kidneys. Research shows that people who don't fill prescriptions or take medications as they're prescribed are more likely to get sicker, and become hospitalized, said Kennedy in an e-mail.
"Nonadherence is a widespread and serious public health problem."
There are signs that the people who volunteered to fill out questionnaires may not be entirely representative of the population as a whole, the authors caution. Half of the volunteers were 32 or younger, and the elderly are more likely to have more prescriptions and therefore more trouble paying for them, said Rhodes.
In addition, it's quite possible that people with money concerns might be less likely to volunteer to answer questions about that problem, she added.
"This is just the tip of the iceberg, and it's probably just an underestimate of the problem."
The next logical step, said Kennedy, would be to track how many people actually filled their prescriptions after a doctor's visit.
"Clinicians need to ask their patients if they can afford to fill their prescriptions, and work with them to make sure they get the medications they are prescribed," he said.