Patient Compliance and Solutions

Many stroke survivors are patients for the rest of their lives. They remain under a doctor’s care, taking medications and living with dietary, exercise and stress management directions. But not following the doctor’s guidance is a costly and growing problem.

If you are having trouble following your doctors’ orders, start with this list to begin confronting the problem.
 

Internal Barriers

Denial

For many, taking a prescription reminds them that they’re sick. You might take your dose one day and skip the next to see if anything happens. Although you might not feel noticeably better or worse in the moment, not taking your medications may have long-term consequences.

Stubborn refusal

Some patients just won’t cooperate. They may refuse to take their medications because of unpleasant side effects. Others may expect immediate results and quit when they don’t see them. If they doubt their treatment plan is effective, they’re likely to resist.

Cognitive deficits

Short-term memory loss can make maintaining even a simple medication schedule challenging. Some patients have difficulty doing the complicated sequencing that multiple prescriptions require. Dementia or memory loss are especially serious for people with high blood pressure or diabetes because the conditions require constant monitoring.

Lack of knowledge

Many stroke survivors leave the hospital not understanding how the stroke happened or the therapeutic strategy or its goals. Some don’t understand the underlying condition that may have caused the stroke. They’re unprepared for the amount and complexity of information that comes with a new diagnosis. The internet contains a lot of health information, but that doesn’t mean it’s accurate. Always be concerned about the source of information, and never act on anything until you’ve discussed it with your health care team. Not all websites are created equal. Timely and reliable information can be found through these trustworthy organizations:

• American Stroke Association
• Food and Drug Administration
• American Diabetes Association
• National Institute of Health

Life gets busy and other priorities get in the way

It seems like taking a pill every day would be easy, but sometimes what is easy to do is easy not to do. At first, your medication may be the highest priority. But eventually, other priorities come up, shifting your attention.
 

External Challenges

Challenge: Not enough time with the doctor

Your time with a health care professional is often limited, restricting education and your ability to ask questions. Patients who don’t understand their treatment or its rationale have a hard time following directions.

• Go to your appointment with written questions.
• Find out as much as you can about your condition and write down questions to ask your doctor.
• Keep a pad where you store your medications so you’ll have a central place for jotting down questions.
• Bring a family member or someone you trust to take notes.
• Record the doctor’s orders so you can review them.

Challenge: Too many medications and complicated lifestyle instructions to eat better, move more and stress less

Many stroke survivors take multiple medications. And the more complicated the drug or lifestyle recommendation, the less likely a patient will follow it.

• Create a medication map — a schedule that covers the whole day. It plots timing, dose and special instructions, such as nutritional support. It organizes all your medication in one place so you see at a glance what, when and how much you should take. A dosing calendar is also helpful because you can check off the date after taking your medicine.
• Schedule a “brown bag” session with your doctor or pharmacist. Put all your prescription and non-prescription medications in a bag and take them to your doctor’s office or pharmacy. They may find overlapping or duplicate prescriptions from different doctors.
• Download our medication tracker (PDF)

Challenge: Multiple doctors

Patients may have several doctors and get conflicting advice and recommendations. As a result, they may make uninformed choices or give up all together.

• Find a doctor you trust and ask them to be the ultimate authority over your treatment. This way, you won’t have to make uninformed decisions about conflicting advice or therapies.
• Ask your pharmacist to review all your medications for problem interactions and then ask your primary care professional to resolve the problem.

Challenge: Cost

Medications are expensive. Even patients with good insurance may have a policy that’s lacking in prescription coverage.

• Comparison shop.
• Investigate the prices charged for your prescriptions at several pharmacies. Also check prices at online pharmacies.
• Ask if your pharmacy offers a discount program.
• Reduce copayments by using extended 90-day prescriptions.
• Most drug companies have patient assistance programs that discount certain drugs.
• Do a little internet research, using reputable sites, and ask your doctor for guidance.
• Ask your doctor about cheaper alternatives. Before you leave your doctor’s office, find out if your prescription is covered by your insurance plan. If it isn’t, they may be able to switch you to a medication that is.

Challenge: Physical limitations

• If possible, have medications delivered or picked up for you.
• Online ordering essentially brings the pharmacy to your door. Inquire about whether your pharmacy offers internet ordering.
• If you can’t get on the internet, ask a trusted friend or relative to place the order for you or find out if your doctor can do it for you.
• You may also find a local pharmacy or a mail order pharmacy that takes phone orders and delivers.