The World Health Organization defines medication (or treatment) adherence as “the degree to which the person’s behaviour corresponds with the agreed recommendations from a health care provider”. In other words, treatment adherence means how closely you follow the instructions for a medication you are given. If you take your medications correctly, you are adhering to your treatment.

Studies have shown that 30 to 60 per cent of people do not take their medications correctly. This percentage increases with the number of medications a person takes, and the number of times each day they must be taken.

Since seniors tend to have more serious medical conditions, they take more medications and are most likely to use them incorrectly. As well, some medications are quite expensive. It is not hard to see why some find it difficult to stick with the therapy exactly as prescribed.

Why is treatment adherence important?

You may ask, “Does it really matter how I take my medications?” “Why do I need to take this with food?” “Why do I have to take it four times a day? Can’t I take it all at once?” “Well, if one pill is good, then taking two should be twice as good.”

The Five Cs of Medication
Correct medication for you	Take only the medication prescribed or recommended for you. Do not share your medications with anyone else.
Correct dose	Take the correct amount of drug each time. Do not double up on doses, unless otherwise directed. Measure liquid medications properly.
Correct time of day	Take medications at the right time of day, if this is specified.
Correct way	Take medications as directed, such as on an empty stomach. Do not split tablets that have a special coating. Use your medication in the right area of the body. Store your medications at the correct temperature.
Correct duration of therapy	Take your medication for the specified length of time. Do not stop early. Do not use a medication longer than is recommended. Keep up with ‘preventer’ medications.

A closer look at the Five Corrects, or Cs, of taking medication shows why it is important to follow directions closely (see table).

Correct medication for you

Not all medications work the same way for everyone. As well, what has worked in the past may not necessarily be appropriate for your condition now.

Mary has a chest infection. She wants to know whether the remaining antibiotics from a urine infection she had a few months ago can treat her chest infection. She does not want to fill another prescription for a second antibiotic. At the same time, her husband Dan, who has high blood pressure, has a cold. He wants to take Mary’s cold and sinus medication, since it works well for her.

In both cases, the medication each wants to use is not appropriate. For Mary, an antibiotic for one part of the body may not work against different bacteria in another part of the body. As for Dan, most sinus medication contains a decongestant, which can raise his blood pressure.

Remember, take only the medication prescribed or recommended for you.

Correct dose

Taking too much medication can cause unwanted side effects that could be harmful. If you missed a dose, and it is almost time for your next dose, do not double up unless told to do so. For instance, too much warfarin (a blood thinner) taken at one time can cause bleeding.

On the other hand, taking too little medication may result in drugs not working as they should. Some drugs, such as antibiotics and birth control pills, require a constant level of drug in the body to be effective. When you delay or skip a dose, the drug levels in the body drop.

Note that different dosages are suitable for children, the elderly, and those with certain medical conditions. A regular dose may be too much for them.

For liquid medication, use a medication measuring spoon or syringe to ensure you are getting the correct amount in each dose.

Correct time of day

Many medications are meant to be taken only as needed, so it does not matter what time of day you take them. However, some medications work better when taken at a specific time of day. For instance, cholesterol is made by the liver at night, when you eat the least amount of cholesterol. So, the most effective time to take certain cholesterol-lowering medications is in the evening. This way, the drug effect peaks during the night. Note that this is only true for simvastatin (Zocor™), pravastatin (Pravachol™), and fluvastatin (Lescol™) as they stay in the body for only a few hours.

Taking medications at the recommended time also helps avoid unnecessary side effects. For instance, taking a medication that causes insomnia early in the morning reduces the chance that it will affect sleep at night.

Correct way

“Can I take it with food?” “Can I split this tablet?” “How do I use this medication?” Ask your pharmacist such questions before you start using a medication. Many medications cause less stomach upset when taken with food. However, others (such as tetracycline, ciprofloxacin and medications for osteoporosis) require an empty stomach to work properly. If these medications are not taken when the stomach is empty, the vitamins and minerals found in food and supplements bind with the drug. As a result, the medication may not work as well or at all.

Take care if splitting tablets that do not have a groove. If you must split tablets, use a proper pill splitter or ask your pharmacist to do so. Do not split medications with SR, CR, XL, or XR in the drug name. These have a special coating or work in a special way with a sustained or delayed release action. Splitting these tablets means that medication is released all at once, or that the drug does not reach where it should go in your body.

Make sure you understand what route your medication is taken or used. Should it be delivered by mouth, into the nose, vaginally, or in the ears? Note special storage instructions and any precautions. Do not refrigerate items such as liquids, eye drops, and creams, unless instructed to do so. Some medications crystallize or gel and so lose their effect.

Correct duration of therapy

When is it acceptable to stop a medication? This depends on how serious your condition is, and whether the medication is treating an acute (short-term) or chronic (long-term) condition. For instance, antibiotic therapy should not be stopped early even if you start to feel better. Doing so may allow the infection to return. It can also cause antibiotic resistance, where bacteria in your body no longer respond to the medication. In this case, medication may not work for you in the future.

Other medications take time before the full benefit is seen. Medications like antidepressants and acne medications require at least four to eight weeks of use in order to see improvement.

Still other medications can be used only a little while before problems may occur. Nasal spray decongestants should only be used three to five days at the most. Rebound nasal congestion may occur with longer use. Similarly, long use of stimulant laxatives like senna may make the bowel ‘lazy’. Frequent and long term use of steroids placed on the skin, such as hydrocortisone, can cause skin to thin along with other side effects.

Perhaps the hardest therapies to stick to are those meant to prevent a condition from occurring. Such medications are called ‘preventers’ for a reason. Continuing a preventer (or prophylactic) medication will lessen the severity and number of flare-ups. Prophylactic medications exist for conditions such as gout, inflammatory bowel disease and asthma.

What will happen if I do not follow the Five Cs?

Not sticking to medication routines can mean many health problems. It may result in unnecessary side effects or drug interactions. The treatment may fail. Often your condition may be made worse or last longer. With a chronic condition like diabetes, high cholesterol or heart disease, you are more likely to land in the hospital.

If you are uncertain whether you are taking your medications correctly, always check with a health care professional. This applies even if you have been taking your medications for a long time.

What can I do?

The following recommendations will help you make the most of your medications.

Stay informed! Understand the Five Cs for each of your medications. Know the benefits of taking your medications as well as the risks of not taking them.
Note any side effects or difficulties with taking your medications and talk to your doctor or pharmacist about them. Often there are other choices.
Keep all your doctor appointments and go for regular check-ups.
Your pharmacist will review all medications to identify drug related problems, help resolve them, allow you to better understand what the medications do and have an up-to-date list for when you travel or seek other healthcare services.
Remember to take your medications. Dosettes, timers, and blister packs may help. Find ways to link your medication schedule with other daily activities. For instance, put your medications with your glasses or toothbrush.
Refill your prescriptions before you run out.
Access resources such as community support groups and free health programs such as Safeway’s Health Inform, Symbicort Program, Dicetel Program, Twinrix Program and others.
Be realistic with your expectations of the time it will take for you to see improvement.
Ask questions!

Take as Directed Why is this so important?

Many people have forgotten to take medication on time or found directions too complicated to follow. Some stop treatment as soon as they feel better. Others decide not to take prescribed medications because they feel they do not really need them. Why is it important to take medication as directed?

What is treatment adherence?