路透健康新闻（Reuters Health）日前报道“很多患心肌梗死的老年人出院后未能按照医生的医嘱继续配药、服药/ Older people who've suffered a heart attack often don't stick with the drugs their doctor prescribes”，出现这一本不应该出现的情况不外是“部分老年朋友对自己的健康不够重视，或因行动不便、经费困难等未能及时配药，或因脑功能受损如痴呆而不能够生活自理”等。

如何才能够帮助和/或提高老年人遵从医嘱如按时按要求服药呢？本人认为：一是在日常生活中，经常接触老年人的朋友如家人、保姆、医护人员或社区工作者都要特别留意老年人的健康状况；二要加强对老年朋友们的健康教育，让他们知晓按时、按要求服药的必要性与重要性；三要帮助经济困难和/或有残障的老年朋友及时获得药物和服药；四要时时留意老年朋友是否按医生的医嘱及时配药、服药，并注意提醒，以免漏服和/或错服药物，以缓解他或她们的病情，进而改善其生活质量。

老年人往往同时患有多种疾病，平时需要服用的药物种类、剂型较多，加之他们大多行动不便、记忆力减退等，及其部分老年人对自身的健康并不特别关心，故极易出现漏服和/或错服药物的现象，而值得大家关注！

Many heart attack patients don't refill their meds

NEW YORK (Reuters Health) - Older people who've suffered a heart attack often don't stick with the drugs their doctor prescribes, although the medications have been proven to save lives, according to a new study.

Seniors filled prescriptions for the clot-buster drug clopidogrel (Plavix) less than half the time on average, for instance. And the less diligent they were at getting their meds, the more likely they were to have health problems and die early, researchers found.

Given that the drugs are known to be helpful, "it should be no surprise that patients who actually don't take their medications for various reasons don't get as much of that benefit," said Dr. Kim Eagle, who heads the Cardiovascular Center at the University of Michigan Health System and was not involved in the study.

After a heart attack, patients are typically prescribed a number of drugs to prevent another one, including a clot-buster, blood pressure drugs, beta-blockers and statins.

Clinical trials have proven that the drugs are effective. Ilene Zuckerman of the University of Maryland School of Pharmacy, who led the new study, said she and her colleagues wanted to see how the medications are used in the real world. Their work was funded by drugmaker GlaxoSmithKline.

The researchers, who published their results in the Journal of the American Geriatrics Society, collected medical and prescription information from more than 9,500 Medicare beneficiaries who had survived a heart attack.

Within one month of leaving the hospital, 59 percent of people filled a prescription for one of two kinds of blood pressure drugs, 51 percent filled a prescription for a beta-blocker, 54 percent for a statin and 46 percent for clopidogrel.

Overall, during the first year and a half following the heart attack, adherence to the drugs ranged from 37 percent to 50 percent.

Zuckerman said she was surprised to see the use of these drugs being so low, knowing that they are a standard part of care for heart attack patients.

Patients who refilled their prescriptions - except for those for beta-blockers, a drug that has become increasingly controversial - were less likely to die early or experience a stroke, heart failure or another heart.

People who filled all or almost all of their statin prescriptions, for instance, saw a 29-percent reduction in the risk of dying early or having another serious health event compared with those who rarely took the drugs.

It's impossible to say for certain that those health benefits can be chalked up to the medicine alone, since people who fill their prescriptions regularly may also be more health conscious overall or have other characteristics that could make a difference.

Still, Zuckerman, who is on a contract with GlaxoSmithKline, said the study confirms the drug benefits seen in clinical trials.

"It suggests that if we could improve the use of these drugs, have people take them more regularly, that we could potentially improve outcomes," she told Reuters Health.

How to do that isn't clear, though.

"There are very few known effective interventions for medication adherence," said Dr. John Rumsfeld, the national director of cardiology for the U.S. Veterans Health Administration, who was not involved in the study.

In addition, it's not entirely clear why patients don't always stick with their medicine.

In some cases, instructions to patients might not be clear or they might lack health insurance or face high copays for drugs. A study out earlier this week, for instance, shows lower copays on certain heart drugs may boost adherence somewhat (see Reuters Health report of October 3, 2012).

In other cases, patients might experience side effects on the drugs. And then there's the role of the patient.

"Both physicians and non-physician care givers, we don't, I think, understand the natural inertia for patients is to stop taking their drugs -whether it's because of co-pays or side effects or 'I just forgot' or 'I don't feel bad, so why do I have to take these five pills,'" said Eagle.

Eagle said that in his experience, people often discontinue a drug because they receive a good bill of health, not understanding that the drugs are important to maintaining that good health.

"We need a system that explicitly asks the question, 'Am I on the right medications, what are they for, do I have refills?'" he added.

Rumsfeld called for more research to help patients stay on prescribed medications. He said doctors are great at helping people survive a heart attack, but not so good at following up after the immediate crisis.

"The vast majority of patients survive heart attacks - it's about stabilization and initiation of key therapies - and I think what we need to now focus on is maintenance and sustainment of treatment over time," he said.

SOURCE: http://bit.ly/T5mhux Journal of the American Geriatrics Society, online September 24, 2012.