Volume 3, Issue 1 - Winter 2012

Common Cold Medications: Real Threat to Compliance?

December 27, 2012

Introduction:

The common cold is the most frequent infectious disease in humans, with an average two to four infections per year in adults and up to 6-12 in children (1).  Collectively, rhinitis, pharyngitis, sinusitis, epiglottitis, laryngitis, and tracheitis, and other infections with similar symptoms are included in the diagnosis of upper respiratory tract infections (URI).  In the US, an estimated 25 million individuals seek medical care for uncomplicated URI annually (2,3).   Americans spend $2.9 billion annually on over-the-counter (OTC) medications and $400 million annually on drugs prescribed for symptomatic relief (4,5).

Polypharmacy – the need to take a large quantity of prescribed and OTC medications on a regular basis – decreases compliance with therapy, increase the possibility of side effects (adverse medication reactions) and drug-drug interactions.  Adults, especially those with multiple chronic conditions like diabetes, hypertension, hypercholesterolemia, osteoporosis, constipation and depression, can often be prescribed more than a dozen different medications daily (6).

 Non-compliance is a major obstacle to the effective delivery of health care.  Only about 50% of patients with chronic diseases in developed countries follow treatment recommendations (7).  Low rates of adherence to therapies for chronic conditions are thought to contribute substantially to the human and economic burden of those conditions (7).  Some of the major barriers to compliance are thought to include modern medication regimen complexity, lack of comprehension of treatment and compliance benefits, occurrence of unknown side effects, cost of medications, and poor communication or patient-physician relationship (8,9,10).

The patient’s need for doctor’s appointment may be influenced by similar barriers.  During the visit, the healthcare provider should educate the patient about the causes, progression, outcomes, and possible treatments of his ailments, including URI symptoms as well as often providing advice for medication compliance.  The doctor is finally a teacher – someone who helps improve patient’s knowledge with what they need to help themselves (11).

In our daily practice at the Family Medicine Center at the Brooklyn Hospital Center we have observed poor compliance with regular medications while treating common URI symptoms, but we are not sure of the reason and the consequences this practice may cause on our patients.

Our study was aimed to determine the incidence of non-compliance and the factors that influence patients with URI symptoms to stop their regular medications while taking different OTC drugs.  Similarly, we tried to analyze patient’s need for subsequent follow up due to poor response or secondary effects of OTC medicines in the Family Medicine Center at the Brooklyn Hospital Center.

We hypothesized that patients with multiple comorbidities on regular medications often stop their medicines while taking OTC medicines to relieve cold symptoms and that multiple variables influence their decision to seek medical attention while experiencing common cold symptoms.  We tried to demonstrate the association between non-compliance and OTC medication use for URI.  Finally, we tried to identify possible reasons as to why patients may prefer OTC use instead of seeking medical attention.

Our study intent was to investigate if there exist a real correlation between using OTC meds for URI and stopping regular medications, with the possible reasons and consequences.  Furthermore, we wanted to use the results of our study to encourage health care professionals to provide medication adherence counseling to patients and teaching about URI as well as to teach patients on the different medication side effects and importance of continuing regular medications while treating URI symptoms.

Methodology:

We asked adult patients presenting for their visits at Family Medicine Center at the Brooklyn Hospital Center to participate in the study by completing brief survey.  Only those who have experience URI in the past month and on at least one regular daily medication were included in the study analysis. 

Results were analyzed using statistical software SPSS version 15.0 (SPSS Inc, Chicago IL).  Cross tabulations were performed to draw any associations between predictor and outcome variables.

Results:

Most respondents (78%) used some form of OTC, and majority believed OTC meds gave them only a moderate relief of symptoms.  Most common reason to visit the doctor was the need for prescription or antibiotics while experiencing UTI.  Most common reason not to visit the doctor was symptoms being mild.

From the 62 total surveys 38 recorded as stopping (62%) meds.    The two most common reasons to stop the prescribed (regular or OTC) medications were the need for more advice and the perception of not needing more medications. 

Some surveys were incomplete because many patients found It difficult to understand the meaning of OTC in some questions even though meaning was in previous questions.  The most common errors were recorded on the questions with conditioning.  For future surveys we could probably be to limit the actual number of questions and reducing the conditioning on them to a minimal number.

It appears that majority of patients with regular medications did stop their meds at some point while taking OTC meds.  We could not identify reasons or any correlations due to large number of surveys being incomplete as described above.  Future studies should use more simplified language and perhaps better explanation of the information being asked.

References:

  1. Macnair T.  The Common Cold.  Bbc.co.uk Health, BBC.  http://www.bbc.co.uk/conditions/commoncold.shtml.  Accessed 9/2011.
  2. Gonzales R, Malone DC, Maselli JH, Sande MA.  Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 2001;22(6):757-62.
  3. Heikkinen T, Jrvinen A.  The common cold.  Lancet 2003;361(9351):51-9.
  4. Garibaldi RA.  Epidemiology of community-acquired respiratory tract infections in adults.  Incidence, etiology, and impact.  1985.  Am J Med 78 (6B):32-7  doi:10.1016/0002-9343(85)90361-4. PMID 4014285.
  5. Fendrick AM, Monto AS, Nightengale B, Sarnes M (2003)  the economic burden on non-influenza-related viral respiratory tract infection in the United States.  Arch Intern Med 163 (4):487-94.  Doi:10.1001/archinte.163.4.487.  PMID 12588210.http://archinte.ama-assn.org/cgi/content/full/163/4/487.  Accessed 9/2011.
  6. Hurria A, Cohen HJ.  Practical geriatric assessment.  1998.  ISBN:0521513197.  Cambridge University Press, Medical.
  7. World Health Organization (2003) (PDF). Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization.  ISBN:92-4-154599-2.  http://wwwwho.int/chp/knowledge/publications/adherence_full_report.pdf.  Accessed 9/2011.
  8. “Patient Compliance with statins.” Bandolier 2004.  http://medicine.ox.ac.uk/bandolier/booth/cardiac/patcomp.html.  Accessed 9/2011.
  9. “Enhancing Patient Adherence: Proceedings of the Pinnacle Roundtable Discussion.”  APA Highlights Newsletter.  October 2004.  http://www.pharmacist.com/AM/Template.cfm?Section=Home2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=11174.  Accessed 9/2011.
  10. Ngoh LN.  Health literacy: a barrier to pharmacist-patient communication and medication adherence.  J Am Pharm Assoc (2003) 49(5): e132-46; quiz el47-9.  doi: 10.1331/JAPhA.2009.07075.  PMID 19748861.
  11. Roter D, Hall JA.  Doctors talking with patients/patients talking with doctors: improving communication in medical visits.  Auburn House Paperback (July 30, 1993).  ISBN-10: 0865692343.