February 25, 2011
There is a lot of talk about too much pill-popping to address our health. Lots of stories go around about patients asking doctors for prescriptions. But the other side of the story is that almost half of us who receive prescriptions do not take them. And about 40% of us who do NOT even have to pay for our prescriptions because they are covered by insurance do not follow the doctor’s orders…
Drs. David Cutler and Wendy Everett discuss this dilemma in the article, ‘Thinking outside the pillbox — Medication adherence as a priority for health care reform’. [http://www.nejm.org/doi/full/10.1056/NEJMp1002305] Their analysis considers the fact that not taking the medications our doctors prescribe probably leads to lower quality of life and may shorten the number of years we live. They discuss the estimation that 89,000 Americans who have been prescribed high blood pressure medications and do not take it die prematurely.
And, not taking those prescribed medications…too often results in hospitalization that could have been avoided…adding up to $100 billion… How is that for a goal in talking about health and health care reform? Take your medication to avoid a costly alternative…time in the hospital.
When a doctor talks about long term effects of medication (or any other condition), my reactions and thought processes are related directly to the transtheoretical model. First comes precontemplation where I am shocked that something as simple as taking my medication can have such a serious effect on my health. Then I would progress into contemplation, where I express my anger or discomfort against taking medication. In the preparation stage, I would start thinking about my surroundings and how others may be able to support me once I start taking the medicine. Then comes the action stage, where I actually start to change my daily routine in order to accommodate the new habit of taking medicine. Moving into the maintenance stage, my schedule may have to be shifted around if the medicine has any adverse side effects but I will have to find a way to fit it into my schedule. Finally comes evaluation, where I look back and think to myself how much of a hassle it has been to utilize the doctor’s prescriptions or how it has helped me and my health.
This article relates to the transtheroretical model of behavior change in many ways. I will use the example of the “89,000 Americans who have been prescribed high blood pressure medications and do not take it die prematurely”. When looking at the 5 stages of change there were many different steps the patient took before deciding what action to take (to not take the prescribed medication). In the precontemplation phase the patient is made aware of their high blood pressure and given a prescription pill to lower it. Next in the contemplation phase the patient may have began evaluating their personal values linked to their high blood pressure. For example, maybe they are a smoker, overweight, alcoholic, don’t exercise, consume too much salt in their diet, or even have a family history of high blood pressure. Next, in the preparation phase they began evaluating the environment and getting social support (probably from family members, and other people they know that may have been diagnosed with high blood pressure because it is so prevalent in Americans today). Next in the action phase the patient probably began looking for substitute alternatives for high blood pressure (exercising, meditation, change in diet/lifestyle, etc.). Finally, in the maintenance phase the patient is well aware of their diagnosis and has decided to not take the pills the doctor has advised them to take. Maybe they have decided to live a healthier lifestyle and feel empowered to be able to do this without medication.
While searching for a blog to relate the Trans-theoretical and stages of change model I came across this one and could not think of a better prompt to explain how this process works.
The first step of the stages of change model is pre-contemplation, which is the stage that increasing awareness occurs. An example of this would be feeling symptoms and then inquiring what they mean to figure out a common denominator.
The second step is contemplation, which is expressing the feelings about a problem behavior and then after evaluate personal values linked to problem behavior. An example of this would be venting to your husband or wife about the problem and figuring out the next motion.
The third step is preparation, which would be calling and making an appointment to see the doctor,explaining symptoms, and thinking about long and short term health effects.
The fourth step is taking action. This is where substitute alternatives for the problem behavior are offered. An example of this would be going to the doctor and receiving a prescription for a medication to make the symptoms and problem go away.
The last step is maintenance, which is how this blog relates so well. Maintenance is just as equally important as going and getting a diagnosis. Maintaining the regiment of taking the prescription prescribed by the doctor is the only way to get better and remove the problem behavior. By not taking the medication, you are not making any changes.
In order to turn the this irresponsible downward spiral around the patient must become aware of, make available, and accept policies and empowerment strategies to maintain the new behavior.
Reading this blog shows me many aspects that relate to the Trans theoretical model but before relating this, I have a story relating to this topic.
A few years ago when I was late in High school my father comes home from the doctors depressed. He told me that his doctor told him that his cholesterol is at a high in his blood. My father was upset more because he was assigned prescription pills to thin his blood. After a few days my father then told me he did research and found he could find organic/herbal supplements rather then doctor perscription pills.
After finding herbal supplements and taking them for a month my father then went to the doctors and found that his cholesterol level wise decreasing and it was not because of the prescription pills. My father told his doctor that he was exercising, eating healthy, and taking his herbal supplements which I think were fish oil pills.
This choice was a lot better then taking the prescription pills. My father used a personal choice to better his situation with cholesterol which deals mainly with the Trans theoretical model. Instead of just taking the pills, my father researched, exercised, and took the best option to better himself medically. Hes doing great to this day!!
The idea of failing to adhere to a prescription medication regime directly ties to the Transtheoretical/ Stage of Change Model. Receiving a new diagnosis that requires daily medication use may be invasive news, especially if the person receiving it otherwise perceives him or herself as “healthy”.
For example, consider a man in his mid- 50’s who has just learned that he has high blood pressure, even though he is not directly feeling the effects of his condition. He is in the precontemplation stage of the SOC model as he becomes aware of his situation.
His doctor may then recommend a blood pressure medication to help lower or control it. The man then enters the contemplation stage as he reacts to the suggestion. Because he may not feel the immediate effects of his high blood pressure, then he may react negatively and harbor ill feelings towards taking a blood pressure medication at his “young age”. On the other hand, he may understand the implications of his diagnosis and willingly accept taking the medication.
As he moves into the preparation stage, he may do more research about the causes of high blood pressure, talk to family or friends about the news, or call his insurance company to inquire about the cost of his prescription. All of these steps prepare him to make behavioral changes that deal with his high blood pressure.
It is during the action stage that a failure to commit to the new behavior may become a problem. Thinking positively, he may start taking his medication on a daily basis, alter his diet, or join a gym for exercise. Also, he may engage his wife by telling her about his plans to change. In other situations, which are unfortunately common, people may not feel a need to be on the medication and “forget” or refuse to take it. This decision, as the article points out, has serious implications in the future. What could have been a manageable condition may eventually become heart disease and leave the patient at the mercy of the disease.
Hopefully, patients will chose to listen to the advice of the doctor and eventually enter the maintenance stage. This particular patient may visit his doctor 3 months later and compare his new blood pressure levels. If they dropped, then he can celebrate his achievements and start to feel confident in his health. Since his adopted strategies seem to be working, then he may continue to use them in order to stay healthy in the long run.
Unfortunately, many people fail to adopt new behaviors, and suffer the consequences of their decisions later in life. This not only affects the individual, however. Family, friends, communities, and the entire country are ultimately affected because the person then requires more resources to control his or her more serious medical condition. This domino effect demonstrates just how important the SOC theory and actual practice of adopting new behaviors are for individual as well as societal health.