Garth Rattray | Help us to help you

There have been significant advances in medicine over the past forty years, yet the incidence, morbidity and mortality from non-communicable diseases (NCDs) is astonishingly high and on the rise.

A big contributing factor is the lifestyle of modern-day society, which does not lend itself to exercise and proper nutrition. Space, time and financial constraints force many people into the habit of fast-food consumption.

The cost of proper nutrition products is astronomical, and the opportunities to relax, recreate, and exercise are very limited. Consequently, we have problems with weight management, hypertension, diabetes, and high lipid levels. However, medical science has been developing remarkable medications to ameliorate those issues.

Back in 1981, there were only a few medications available to regulate blood pressure. Thiazide diuretics, alpha-blockers, beta-blockers, calcium channel blockers, and some centrally acting anti-hypertensive medications like clonidine and methyldopa were heavily depended upon. Perhaps reserpine was around. It was about that time that the first angiotensin-converting enzyme (ACE) inhibitor was approved.

There are hundreds of different anti-hypertensive medications available today. Suffice it to say, there are at least 8 main classes, with each class containing several individual medications, with slightly different characteristics and actions. They range from ACE inhibitors to peripheral adrenergic inhibitors, and even a direct renin inhibitor.

When it comes to diabetes, back in 1981 sulfonylureas and insulin were the primary treatment. Others like biguanides (metformin for instance) were around but not widely available. However, today there are more than 50 different glucose-lowering (oral and injectable) medications available. Those range from sulfonylureas to sodium-glucose cotransporter 2 inhibitors (SGLT2) inhibitors, and dopamine-2 agonists.

There are several types of insulin preparations: like rapid, short, intermediate-acting, and premixed. More recently there are the non-insulin injectables like glucagon-like peptide-1 (GLP-1) receptor agonists that stimulate insulin release and reduce glucagon secretion (these often lead to weight loss). Additionally, we have dual GLP-1 receptor and GIP receptor agonists combine the effects of GLP-1 and GIP receptors, and an amylin analogue.

Cholesterol-lowering agents now include [among others] statins, bile acid sequesters, and fibrates.

Despite our problem with modern-day living, you would believe that, with such a wide array of very effective medications, there would be reasonable control of our various NCD’s. The problem here is that, notwithstanding our best individual and national efforts, only about half of the people who are prescribed essential medications take them.

Several months ago, a young physician brought her father to see me. I am their family physician, and it was very evident to me that something was amiss. The doctor voiced her concern that her father’s hypertension was far out of control. She suggested that I should add another blood pressure lowering agent.

During all of this, her dad sat staring silently at the desk. I recognised that look and simply asked him, “Are you taking your medication?” His response was a swift …. “No.” I knew that his daughter learned a very valuable lesson. Many patients do not take their prescribed medications … especially if they are for an NCD or for several NCDs. Her dad began taking his medication and his blood pressure is now under good control.

The World Health Organization (WHO) states that about half of the patients do not take their medications. The term for this is medication non-adherence. This is a very troubling problem that contributes to “poor patient outcomes, increased healthcare costs, and even premature deaths.”

The causes of nonadherence are varied. It may be caused by certain beliefs and misunderstandings. Because of our culture, more than just a few Jamaicans prefer natural herbs as medicine for their hypertension, diabetes, and lipid problems. Even when the various medications prove themselves to be far more effective than their ‘natural’ counterparts, many people site their fear of side effects as their distrust for prescribed, laboratory-produced products.

However, medications do not always have side effects; they might have side effects. This is also true of the natural medicines that people take so trustingly and readily. Furthermore, the ‘side effects’ of not treating hypertension, diabetes, and lipid problems are always serious, incapacitating and deadly because they include major heart, brain, kidney, and circulation problems.

Patients tend to overlook medications if they have a lot of medications swallowing every day. Combination pills are very helpful in these circumstances. They don’t feel motivated to take pills day in and day out if their problems do not give them any symptoms. For instance, hypertension and elevated lipids are notoriously asymptomatic. Diabetes is symptomatic only when the glucose level is extraordinarily high or extremely low. Patients tend to avoid medications unless they feel pain or are feeling unwell.

The other reasons for patients’ non-adherence include difficulty understanding the reason for taking medications, how the medications should be taken, the need to continue taking prescribed medications because the disease process is unrelenting and noncompromising, and some also have problems remembering what medications to take when. Using a pill container to put out the week’s medication(s) in advance and keeping that container in an easy to see location is critical.

Healthcare providers should be aware that patients hate having to ‘live on’, medications indefinitely and do their best to explain how important it is to take them. Recruiting patients to help us to help them involves teamwork involving the prescribing primary healthcare provider, the dispensing pharmacists and the relatives at home.

Achieving patient adherence will decidedly turn the tide in our favour when it comes to all the non-communicable diseases. People would enjoy far better lives and live longer.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.