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Toni Talks about PT Today

Medical Noncompliance

Published September 13, 2011 1:07 PM by Toni Patt

I've noticed another trend in my stroke population. More and more patients are being admitted with strokes because they haven't been taking their medicine. The frequency has increased from one or two a month to at least that many in a week. This morning, I evaluated three patients who weren't taking their antihypertensive medications. All had NIHSS scores greater than 12, which isn't good.

There are many reasons why patients don't take their medication. Surprisingly, medicine cost is rarely the reason. Most of them just stop taking the medicine because they felt OK and didn't think they needed to continue. There is a sort of sad logic to that. Of course they felt better. The medicines were doing what they were supposed to be doing.

I've also noticed that strokes resulting from medical noncompliance seem to more severe. These people usually don't go home in a couple days. They have strokes that require prolonged hospitalization, inpatient therapy and disability. All three of my evaluations from this morning will go to a SNF when they leave my hospital.

People must not understand the relationship between medicine and stroke prevention. I've heard patients ask if the stroke was related to not taking medicine. Others are just surprised. No one believes anything bad will happen if they stop taking their medicine. There seems to be a disconnect between not taking medicine and bad outcomes. No one thinks it will happen.

This is one of those times I would like to take some pictures of my patients and post them elsewhere in the hospital with the heading, "This is what happens when you don't take your medicine." Obviously I can't. It wouldn't do any good if I did because the guilty wouldn't recognize themselves. Taking medication is the easiest way to prevent a stroke. Yet people won't do it.

I know my population is very unique. I only work with stroke patients so I see this sort of thing more frequently. But I see it too frequently. It will probably get worse if the economy doesn't improve. Inability to afford medication could become a significant problem.

This means we'll be seeing more stroke patients in our practices. It also means a greater demand on PT services. Stroke patients tend to require therapy longer than other diagnoses. There is nothing we can do about it until the patients come into our care. By then the damage is done and we're trying to make the best of a situation that could have been prevented. That statement is what bothers me most about this. The majority of these strokes could have been prevented by simply taking medication.


I wonder how well people are taught about taking their medications. When I was doing intake evaluations in NY, we had to take a medication history on each patient which included the questions: "Do you know what this medication is for? Do you know how and when to take this medication? and Do you know what the side effects of this medication are?" Most people couldn't answer those 3 questions. Another problem is that medications are not reviewed at least annually with GPs or PCPs. Someone on BP medication for 20 years may need more or less or a different medication now. We see this frequently in our falls clinic, people who were very heavy when they began taking a particular BP medication who then lost weight and/or became more frail who were then overmedicated.

You bring up an excellent topic. We as PTs should be advocates for our patients and cue them to have regular medication reviews and to support them in understanding their medications better.

Dean Metz September 17, 2011 2:23 PM

Interesting.  I'm writing an upcoming blog about the reverse of this, sort of.  Or at least a different take.  

In the same month, I had two people who were in dire medical conditions because of medication they were taking exactly as prescribed.  One had been on the blood pressure medicine for 30 years without any ill effect, then suddenly began behaving as though she had a neuro insult and was sent to rule out brain cancer.  She's been off the medication now for over a month with sustained normal blood pressure.  The other one was a kid with neuro symptoms who was taken to the ER via ambulance three times in six days before the medical team finally called a neuro consult and admitted - at the only hospital in the city that staffs pediatric neurologists.  

One of my most unique memories is of a patient with stroke symptoms that were medically induced.  She showed classic hemiplegia and also had visual hallucinations.  She had multiple docs prescribing while she was hospitalized and someone wasn't paying attention.  One day she woke up symptomatic and was diagnosed with a stroke.  Once they figured it out, she went from difficulty with wheelchair mobility and complete inability to ambulate to independent ambulation in less than 24 hours.  

I know that last example is a medical mismanagement, but the first example makes me wonder about lifetime pharmaceutical therapy.  

Janey Goude September 16, 2011 3:11 AM

Yury from Russia. Thanx for the post! I mostly work with post-stroke patients in home settings. I also liked "The medicines were doing what they were supposed to be doing" very much.

Yury Moostafaev, neuro-rehab PT September 15, 2011 4:43 PM

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