Patient adherence to medication

Prescription of medication is a key part of healthcare today, and because of medical advances and increased longevity, more patients are prescribed multiple medications. Patient adherence is critical to medicine-taking, but the process of taking medicine has been studied much less than the medications.1

According to the WHO (2003) report on medication adherence, the definition of adherence to long-term therapy has been stated as “the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.”2

Poor medication adherence is a growing public health concern3, and it is a significant problem worldwide.2

About 50% of patients in developed countries adhere to long-term therapy for chronic illnesses, and an estimated one-third to one-half of all medications for long-term conditions are not taken as recommended.1

For example, in studies referenced by the WHO report mentioned above, in the United States, just over half of hypertension patients are compliant. In Australia, only 43% of patients treated for asthma adhere to their prescribed medication regimen, and just 28% use prescribed medication to prevent symptoms. Developing countries have still lower rates.2
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As the chronic disease burden grows throughout the world, the problems caused by poor medication adherence increase,2 and addressing the problem of non-adherence to medications is becoming critical. Poor adherence can cause poor outcomes and higher treatment costs.2 Failure to adhere can decrease the benefit of a medication, reducing effectiveness and possibly leading to declining health.4 About 30% to 50% of treatment failures, as well as 125,000 deaths, occur each year as a result of non-adherence.5

Patients’ lack of adherence can be caused by social factors, the healthcare system, specifics of their diseases, medication costs, available therapies, and individual factors. An ongoing effort is required to improve adherence.2 Interventions to improve adherence would require a careful review of the issues affecting it and what can be done to address them.

According to the American College of Preventive Medicine, the interventions to promote adherence can and should be “SIMPLE”. As per the mnemonic, some of the key points are: 6

S – Simplify the regimen by adjusting timing, frequency, amount, and dosage, or match the regimen to patients’ daily activities.

I – Impart knowledge by having a focus on patient-provider shared decision-making, providing clear instructions (written and verbal) for all prescriptions and suggesting additional information from the Internet if patients are interested. Provide specific sites or links, to ensure that the patient is reading accurate information. Patient education, a simplified regimen, and good communication together can promote change.6

M – Modify patient beliefs and behavior by empowering them to self-manage their conditions, addressing their fears and concerns, and also asking the patients to describe the consequences of not taking their medications to reinforce their understanding.

P – Provide communication and trust. Physicians can improve on active listening, providing emotional support by treating the whole patient and not just the disease, and speaking in simple language. They should also allow adequate time for patients to ask questions.

Patient-provider concordance plays a unique and important role in assuring that patients adhere to their medications. The doctor must gain the patient’s trust and provide treatment that agrees with the patient’s belief system. The doctor should also see that the patient agrees with the treatment and can take medications properly and on the correct schedule, and also that the patient can afford to stay on the regimen. Taking time with your patients and having a thorough conversation can result in better outcomes and simpler follow-up appointments.6

L – Leave the bias. Physician interventions that increase patient-physician partnership are important to overcome ethnic, minority, and socioeconomic disparities related to health outcomes. Patients in minority groups often have less patient-centered communication with their providers and may not speak up as readily.

E – Evaluate adherence. Compliance can be improved by measuring it. Asking the patient simply and directly if they are following their drug regimen is a typical method. Confront any barriers to adherence and identify any reluctance to accept medical advice.

Adherence is critical because a non-compliant patient is not actually receiving the prescribed treatment. Healthcare providers have a key role to play in improving adherence rates. Adherence strategies that focus on communication skills and patient-centered care need to be more thoroughly implemented in the training that healthcare providers receive, in order to make a difference.

Dr. Shalini Ratan Dr. Shalini Ratan, MD, is Founder and Chief Knowledge Facilitator at Nirvan Life Sciences Pvt Ltd. Mumbai, India.

References (click to show/hide)

  1. Medicines Adherence: involving patients in decisions about prescribed medicines and supporting adherence. National Collaborating Centre for Primary Care. Royal College of General Practitioners, 2009.
  2. Adherence to long-term therapies: evidence for action. World Health Organization, 2003.
  3. Medication Adherence. Script Your Future. Available on http://www.scriptyourfuture.org/medication-adherence/ as on 18th November, 2013
  4. Medicines adherence. Involving patients in decisions about prescribed medicines and supporting adherence. NICE clinical guideline 76, 2009.
  5. Medication Adherence. CDC’s Noon Conference, March 27, 2013. Available on http://www.cdc.gov/primarycare/materials/medication/ as on 16th November 2013
  6. Medication Adherence Time Tool: Improving Health Outcomes. A Resource from the American College of Preventive Medicine. Available on http://www.acpm.org/?MedAdherTT_ClinRef#Strategies as on 16th November 2013


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