Medication Adherence: Truth and Consequences

Abstract

Improving medication adherence may have a greater influence on the health of our population than in the discovery of any new therapy. Patients are nonadherent to their medicine 50% of the time. Although most physicians believe nonadherence is primarily due to lack of access or forgetfulness, nonadherence can often be an intentional choice made by the patient. Patient concealment of their medication-taking behavior is often motivated by emotions on the part of both provider and patient, leading to potentially dire consequences. A review of the literature highlights critical predictors of adherence including trust, communication and empathy, which are not easily measured by current administrative databases. Multifactorial solutions to improve medication adherence include efforts to improve patients' understanding of medication benefits, access and trust in their provider and health system. Improving providers' recognition and understanding of patients' beliefs, fears and values, as well as their own biases is also necessary to achieve increased medication adherence and population health.

EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice

“…Of those that are automated, interventions often use only basic reminding [16] and thus only address the forgetfulness aspect of the complex and multidimensional problem of nonadherence, which only accounts for 30.3% of missed medication reasons in our sample. As such, the relatively low frequency of “I forgot” responses (30.3%) seems to support the theories of Saberi et al [10] and Brown et al [1] discussed above as they claim nonadherence is a complex, multidimensional problem that is not sufficiently explained by just forgetfulness.…”

“…Nonadherence rates vary widely among different disease contexts and patient populations, but estimates of nonadherence typically range from 50% to 80% [1] with nonadherence notably elevated in asymptomatic [1] and chronic [2] conditions. This ultimately has a major impact on clinical outcomes as nonadherence is estimated to be a major factor in 125,000 deaths per year [3].…”

“…While forgetfulness is often cited as a reason for medication nonadherence, Saberi et al [10] found that interventions relying solely on reminding HIV patients to take their antiretroviral therapy were largely not effective, leading them to speculate that the attributed forgetfulness was a simple excuse for more complex underlying reasons like stigma, depression, drug abuse, and lack of social support. Across all patient contexts, Brown et al [1] have also concluded that although most physicians believe nonadherence is due to forgetfulness or lack of access, it is often a deliberate choice by the patient.…”

Relationship Between Internet Health Information and Patient Compliance Based on Trust: Empirical Study

“…(1) For patients: the probability of morbidity and mortality is likely to increase [31]. (2) For economy: medical productivity and resources may be wasted because patients ignore the medical diagnoses and treatment regimens recommended by their physicians [31,32]. (3) For society: the use of genuinely beneficial drugs may be terminated due to noncompliance in clinical practice [31].…”

“…(3) For society: the use of genuinely beneficial drugs may be terminated due to noncompliance in clinical practice [31]. The treatment of chronic diseases largely relies on self-management and self-monitoring by patients [4]; thus, improving patient compliance may lead to better health-related outcomes than discovering any new therapy, given the increasing proportion of patients with chronic diseases [32]. However, the proportion of high compliant patients is relatively low, with a study revealing the rate of patients’ noncompliance with medicine to be as high as 50% [32].…”