Aiming at Strategies for a Complex Problem of Medical Nonadherence

Abstract

The deteriorating health of the population and the increasing prevalence of chronic diseases are global problems whose causes are multifactorial and complex. The Western lifestyle does not promote healthy living, and the consequences are most devastating when social inequalities, together with the economic and population explosion of recent decades, are considered. The expansion of poor nutritional habits, obesity, sedentarism, and hypertension are increasingly contributing to the development of a cardiovascular disease epidemic. Recent data on the rates of compliance with lifestyle modification and adherence to prescribed medication are alarming. Over 50% of patients, on average, decide to abandon the treatment prescribed, and the objectives to improve their habits (quit smoking, lose weight, or engage in physical activity) are met by an equal or lower percentage. Beyond the impact it has on individual health, it carries a huge economic cost, as it is associated with a failure in achieving therapeutic goals, higher rate of hospitalization, and death. Improving communication between doctors and patients, the active involvement of other health professionals, and the development of combination drug formulations (polypill) are potential strategies for improving adherence and reducing costs.

Clinical Impact of the Polypill for Cardiovascular Prevention in Latin America: A Consensus Statement of the Inter-American Society of Cardiology

“…[60,63,64]) collected lifestyle behavioral data (specifically weight, abdominal circumference, body mass index, and duration of physical activity) and did not find significant differences between patients treated with the polypill compared with those in the control group. Statements and conclusions related to the indication for use of the polypill are depicted in Table 7 [80,81].…”

Ensuring Patient-Centered Access to Cardiovascular Disease Medicines in Low-Income and Middle-Income Countries Through Health-System Strengthening

“…pill burden and side effects) are particularly salient in determining adherence to CVD medicines. 44 Three potential costs -transportation, user fees to see the clinician, and the costs of the medicines themselves -all hinder patients from adhering to essential CVD medicines. The first and most obvious cost barrier, is the price the patient pays to buy the medicine at the pharmacy.…”

“…The daily number of prescribed pills as well as the frequency at which patients must remember to take their medicines are recognized as factors responsible for patients' lack of adherence. 44,49 Additionally, besides availability, medications' side effects have been found to be the most common barrier to patient's adherence to treatment. When translated to clinical significance, side effects had a two-fold increased risk of nonadherence.…”

The Use of Coaching Sessions and a Mobile Reminder Application toEnhance Medication Adherence in Adults at an Outpatient Psychiatric Clinic

“…In light of the Affordable Care Act, requiring policymakers to find new methods of improving healthcare outcomes. Mechanisms to encourage patients to adhere to medication regimens are now a national focus (Castellano, Copeland-Halperin, & Fuster, 2013).…”