EVEN IF THEY have to take the pill only once a day, fewer than three people in four manage to do it correctly, surveys have shown.
If they have to take the medication four times a day, barely 40 percent are able to do it right.
"Now imagine if you were 80 years old and you took 15 different drugs," says Mary Lynn McPherson, a clinical pharmacist and professor of pharmacy at the University of Maryland School of Pharmacy.
Too many people, old and young, get confused about the medications they are taking. They take them at the wrong times, in the wrong way, at the wrong dosages, or in combination with other, incompatible drugs.
Just how many isn't clear, McPherson says, but "it's pretty bad."
In a pioneering effort to help out, McPherson has established a "pharmacotherapy service" at Baltimore's Waxter Center.
One day a week for nearly a year now, she has been helping people sort out their medications, sometimes by the bagful.
She helps them understand the drugs, adjust the dose when necessary in consultation with their doctors, and work out a manageable routine for taking them so that the drugs do what the doctor intended, and no more.
The service is part of the Waxter Medical Services, a private medical practice associated with the University of Maryland. McPherson's help is available to anyone, and is covered by private health insurance plans, as well as by Medicaid and Medicare.
"I'm sure there are others in the country, but this is the first one I'm aware of," she says.
When patients come to her, often referred by doctors, social workers or nurses, McPherson takes a complete drug inventory. Sometimes she asks patients to bring every drug they are taking to her.
When Margaret Green, 72, of East Baltimore, went to see McPherson one day recently at the Waxter Center, she took along a list of medications she was taking for high blood pressure and stomach problems.
But, in the course of a long, patient interview, McPherson learned that Green had been taking other medications, both prescription and over-the-counter, and that her blood pressure was not well-controlled.
Green also complained of muscle weakness that McPherson said could be caused by her medications, memory loss, high blood cholesterol and other ills that needed attention.
"I think her medications need to be adjusted . . . and something needs to be done about her cholesterol," McPherson said. She ordered a series of blood tests and promised to consult with Green's doctor about possible medication changes.
"I think we can help her," she said.
In some cases, McPherson said, a new drug, or a change of dosage will solve patients' problems. Sometimes, when doctors have prescribed drugs B, C and D to deal with side effects of drug A, a change in the original prescription can eliminate several others.
"A lot of people don't know how to take their medications," she said. Many forget, or didn't hear clearly what their doctor told them, and some can't read the label. Many don't clearly understand what the drugs are, or what they're for.
Some succumb to what McPherson calls the "toothbrush effect," taking the drugs only when they're due to see their doctor. Others take them sporadically, a habit that can render the medicine alternately ineffective, or toxic.
McPherson will spend time educating these people and their families. She often custom-designs a medication schedule to the individual's lifestyle, so that even if they normally get up at noon and go to bed at 3 a.m. they'll still know how and when to take their medicine.
She can often find replacement drugs, or alternate forms of drugs that elderly patients, because of physical impairments, have difficulty taking.
She said she can even design a "bubble pack" that contains all of a patient's medications, grouped, for example, so that "all the drugs to be taken at breakfast will be in one little bubble."
McPherson is also available to monitor patients for proper dosage levels. And she regularly teaches diabetics how to use a blood-sugar monitoring machine, how to determine how much insulin they need and how to administer the insulin by injection.
It makes me feel good," she said, "when a diabetic gets [the disease] under control, and they come back and say they just feel so much better now."
Patients interested in making an appointment with McPherson, or adult children concerned about elderly parents, may call 396-1295 for an appointment.