Have Trouble Taking Your Meds?

Medication Nonadherence Is a Complex and Widespread Problem

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Despite disease or prognosis, more than one-third of people fail to take their prescribed medications.  Such nonadherence comes at a huge price to not only the patient but also society as a whole.

Nonadherence leads to increased incidence of patient hospitalizations, longer hospitalizations, and increased expenditure by the government and insurers on such hospitalizations—a price that we all end up paying for.

Moreover, people who are nonadherent to their medication regimens often lose personal independence through placement in long-term care facilities.

Various interventions aimed at increasing adherence have been suggested and studied. Although many of these interventions involve modern technology, improvement of the physician-patient relationship and addressing patient motivations and beliefs remain integral.

Nonadherence: the Whys and Wherefores

In dated literature, adherence would often be referred to as compliance. The AMA Manual of Style, however, now recommends that the word adherence be used instead of compliance because compliance connotes a stigma stemming from the word's association with rule, enforcement, submission and so forth.

According to the AMA Manual of Style, adherence is defined as "the extent to which a patient's behavior (for example, taking medication, following a diet, modifying habits or attending clinics) coincides with medical or health advice."

The World Health Organization (WHO) suggests 5 reasons why we don't adhere to our treatment regimens:

  • Patient-related factors such as visual impairment, cognitive impairment, motivation and so forth.
  • Therapy-related factors including complexity of medication dosing, duration of therapy, perceived lack of benefit, adverse effects and social stigma.
  • Social and economic factors such as language limitations, low health literacy, little social or family support, limited access to health-care resources and so forth.
  • Health-care system factors including problems with the patient-provider relationship, problems with provider communication, patient beliefs and high medication costs.
  • Condition-related factors such as chronicity of disease, lack of symptoms, depression and more.

Improving Adherence: What Can Be Done

Various measures aimed at improving adherence have been floated and researched including the following:

  • electronic health records and "e-prescribing" to reduce medication errors, improve patient access to medication information and improve overall health care;
  • Improved efficiency of medication mass production in order to decrease medication costs;
  • dosage reminders by phone, e-mail or text message;
  • "polypills" which combine up to 4 different medication tablets into one;
  • extended-release medications that require fewer doses;
  • pharmacoengineering which limits medication adverse effects;
  • pharmacoengineering which makes medications easier to take and administer like foams or orodispersible tablets that dissolve in the mouth;
  • improved clinician training and feedback aimed at ameliorating clinician communication and skills;
  • "smart" packaging where a pill bottle is fitted with a processor that sounds an alarm or otherwise notifies you when a medication should be taken;
  • more robust and informative patient-education materials.

Technology also exists that can monitor, record and relay every time the cap of a pill bottle is removed. Such seemingly Orwellian oversight can then be used by your health care provider to determine whether you've been taking your medications. One can imagine that such monitoring may improve adherence; after all, if your physician is privy to exact times you ostensibly take a medication, then you may feel compelled to take your medications more regularly. However, various research studies have demonstrated that such monitoring doesn't increase adherence.

If you or someone you love is nonadherent to a medication or treatment regimen, it's important that such difficulties be discussed with a physician or other health care provider. Often, many reasons for nonadherence can be easily rectified whether it be a change to another medication with fewer or alternative adverse effects, programs to help you pay for medication, or personal concerns that your health-care provider needs to better address. Remember that all the medication or treatment in the world means little in the face of nonadherence.

Selected Sources

"Does Electronic Monitoring Influence Adherence to Medication? Randomized Control Trial of Measurement Reactivity" by S. Sutton and colleagues published in the Annals of Behavioral Medicine in 2014.  Accessed on 12/30/2014.

"Use of modern technology as an aid to medication adherence: an overview" by SC Thompson and AT Walker published in Patient Intelligence in June 2011.  Accessed on 1/6/2015.

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