Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions

Abstract

BackgroundNonadherence with medication is a complex and multidimensional health care problem. The causes may be related to the patient, treatment, and/or health care provider. As a consequence, substantial numbers of patients do not benefit optimally from pharmacotherapy, resulting in increased morbidity and mortality as well as increased societal costs. Several interventions may contribute to improved adherence. However, most interventions have only a modest effect. Thus, despite the many efforts made, there has been little progress made as yet in tackling the problem of nonadherence.MethodsThis paper summarizes the definitions and taxonomy of adherence with medication, as well as types and causes of nonadherence. In addition, interventions aimed at improvement of adherence are discussed.ConclusionThere is not just one solution for the nonadherence problem that fits all patients. Most interventions to improve adherence are aimed at all patients regardless of whether they are adherent or not. Recently, a number of tailored interventions have been described in the literature. Modern techniques are useful. Electronic pill boxes combined with Short Message Service reminders are specifically designed to improve unintentional adherence and have resulted in an increase in refill adherence in diabetic patients with suboptimal adherence. Tailored Internet interventions are a possibility for influencing patient drug-taking behavior and show promising results. Tailored counseling interventions targeted at the underlying causes of nonadherence seem an attractive method for supporting patients with their use of drugs. However, despite the plausible theoretical framework, data on long-term health effects of the various interventions are not available. To improve adherence effectively, there is a need for a tailored approach based on the type and cause of nonadherence and the specific needs of the patient.

Adherence to Secondary Stroke Prevention Therapies in Ischemic Stroke Patients at Teaching Hospital in Central Java Indonesia

“…Patients may be careless or forgetful about adhering to the treatment regimen that they should take. Intervention for this type of non-adherence may need to focus on reminding patients and supporting patient to take their medications in their daily routine [21].…”

The need for (cost)-effective interventions to enhance adherence with osteoporosis medications

“…The same systematic review 13 suggests along five studies that less frequent dosing regimens, electronic prescription, and the use of a patient decision aid to facilitate decision-making by describing the available options could be effective methods to improve adherence. Monitoring and providing feedback to patients on bone marker results seems, however, not an effective way to enhance adherence according to four studies.…”

“…Although the value of the educational support program presented by Nogues et al 8 is probably evident, there remains a need for high quality studies that compare the effectiveness of programs enhancing adherence to osteoporosis medications. Pragmatically designed, randomized, controlled trials, preferably stratified according to patient characteristics and with long-term follow-up, would be required 13 . Different studies regarding different methodological approaches for patients' education should also be carried out (and maybe differ) for different drugs.…”

“…In summary, given the large clinical and economic burden of poor adherence to osteoporosis medications, developing effective and cost-effective interventions to enhance adherence would be extremely worthwhile. Several interventions such as a telephone-based educational support program are promising to improve medication adherence in osteoporosis 13 . To demonstrate that adherence interventions offer benefits, we recommend that such programs are subject to further rigorous clinical (and economic) evaluation.…”

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

“…Moreover, the intervention group had a 10% decrease in mortality over the 5-year follow-up period (P = 0.18). The theory-based core and tailored intervention consisted of electronic monitoring of adherence; Patient-level interventions for nonadherence to immunosuppressive regimens 55,82,83,86,93,95 …”