Medication Nonadherence

Abstract

Medication nonadherence is widely recognized as a common and costly problem. 1 Approximately 30% to 50% of US adults are not adherent to long-term medications leading to an estimated $100 billion in preventable costs annually. 1 The barriers to medication adherence are similar to other complex health behaviors, such as weight loss, which have multiple contributing factors. Despite the widespread prevalence and cost of medication nonadherence, it is undetected and undertreated in a significant proportion of adults across care settings. According to the World Health Organization, "increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments." How can adherence be improved? We propose that the first step is to view medication nonadherence as a diagnosable and treatable medical condition.To treat a medical condition, an accurate diagnosis must first be established. However, for undetected and under-treated conditions such as medication nonadherence, one way to identify the population of interest is to conduct screening. The 1968 World Health Organization principles on screening tests have clear application to medication nonadherence. For example, the condition is an important problem, there are suitable tests available, and there are acceptable treatments for those with this problem. However, most clinicians are not formally trained on screening for, and diagnosing, medication nonadherence, nor are they fully aware of how best to treat nonadherence if detected. As a result, research has shown that clinicians develop varying heuristics surrounding the diagnosis and documentation of medication nonadherence. For example, one of the most common diagnostic assessments for medication nonadherence is simply asking patients if they have any problems taking the medication regimen as prescribed (and assuming the patient's response is accurate). When no further questions are asked, potentially addressable medication issues are left unattended.

Factors predicting self-reported medication low adherence in a large sample of adults in the US general population: a cross-sectional study

“…2 3 In the USA, an estimated $100-290 billion in preventable costs can be realised by improving the estimated 30%-50% adult non-adherence rate to chronic medications. 4 The Congressional Budget Office estimates that a 1% increase in the number of prescriptions filled by beneficiaries would result in a reduction of a fifth of 1% of total Medicare spending on services. 5 The literature on the prevalence of non-adherence is challenging in that estimates vary widely by countries, the methodologies employed (eg, database abstraction from claims databases vs self-report through surveys) and the criteria used to define low adherence.…”

Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

“…The importance of OMT should be emphasized to patients at each clinical encounter to improve compliance. 18 Moreover, hospital-and community-based programs such as the Get With The Guidelines and the Guidelines Applied in Practice initiative may help to improve the prescription of OMT and patient compliance. [46][47][48] Combining the OMT agents in a single tablet (polypill) may also improve adherence.…”

“…[11][12][13][14][15][16] This underuse of OMT might reflect medication nonadherence or issues with the healthcare system or may be related to a paucity of data, leading to an underestimation of importance of OMT and the misconception that continuing OMT may be of less value once diseased coronary arteries have been mechanically revascularized. 17,18 Recent controversies on the use of β-blockers, generally and in noncardiac surgery, and statins may further reduce prescription or compliance, [19][20][21][22] with potential consequences on long-term clinical outcomes. Therefore, a definitive evaluation of role of OMT in patients with complex CAD undergoing PCI or CABG is warranted.…”

Behavior change, health, and health disparities: An introduction

“…Now and for the foreseeable future the challenge must give priority to advancing scientific understanding and management of chronic health conditions, especially those where personal behavior or lifestyle (e.g., cigarette smoking, other substance abuse, physical inactivity, unhealthy food choices, risky sexual behavior) is a proximal cause of chronic disease (e.g., cardiovascular disease, site-specific cancers, type-2 diabetes). Even with chronic conditions where behavior is not a proximal cause, behavior is often a critical factor in terms of adherence to medication and other therapeutic regimens (Marcum et al, 2013). …”