Former Surgeon General C. Everett Koop once said: “Drugs don’t work in people who don’t take them.” This statement of fact underlies the adverse effects of patient nonadherence to medication treatment regimens.
The problem of nonadherence has many roots. Addressing its myriad causes requires an understanding of those causes and an ability to connect causes to individual patients in order to provide the right intervention.
Causes of Patient Nonadherence
Patients’ failure to adhere to treatment regimens is rarely a matter of individual stubbornness or laziness. Rather, many factors combine to result in nonadherence for any given patient.
Lack of Understanding, Communication or Health Literacy
Patients are likely to stop taking their medication if they don’t understand what the medication does or how they should take each dose.
In a 2021 study, Jane E. Hamilton and fellow researchers followed several focus groups of patients and providers, who were asked to discuss medication nonadherence. “Across the focus groups, communication difficulties between patients and providers resulting in medication nonadherence was a primary theme that emerged,” the researchers wrote.
Patients often felt they weren’t getting useful information on side effects, medication effectiveness and costs.
Cost is a major factor in patient nonadherence.
“The correlation between prescription abandonment and medication cost is undeniable,” writes Matt Phillion in Patient Safety & Quality Healthcare. The rate of prescription abandonment — prescriptions that are filled but never picked up or paid for by the patient — rises sharply with cost.
A 2010 study of electronic prescriptions by Michael A. Fischer and fellow researchers found that 78 percent of new prescriptions were filled overall; the rate jumped to 87 percent for patients 18 and younger.
Adherence rates tend to be higher in hospitals, where control of administering medications is in the hands of nursing staff and where adherence is treated as a quality of care issue, subject to regulatory rewards or penalties. In outpatient settings, however, “…services to improve adherence are generally not reimbursed, so even in the outpatient setting, little incentive exists to improve this fundamental aspect of care,” write Jennifer Kim, Kelsy Combs, Jonathan Downs and Frank Tillman III in U.S. Pharmacist.
In addition to an inability to afford medication, broader socioeconomic factors also influence patients’ adherence to medication protocols. Lack of access to transportation or the ability to work with a regular pharmacy can lower medication adherence rates by complicating the process of obtaining medications.
Patients’ relationships with their own family members can reduce adherence as well. In a study of patients with Type 2 diabetes, Jean de Dieu Murwanashyaka and fellow researchers found that patients were more likely to stop taking their diabetes medications if they perceived their condition or its costs to be a burden on their families.
Comorbid Conditions and Other Medical Factors
Patients with multiple medical conditions may face additional complexity in finding a medication regimen that works for them. Patients with chronic conditions may be especially susceptible: Up to 50 percent of patients with chronic conditions do not adhere to their medication protocols, writes Fred Kleinsinger.
Other physical and mental conditions can also make adherence problematic. For instance, difficulty opening medication packaging, trouble swallowing, forgetfulness, or denial of illness can all lead to nonadherence, writes Shalini S. Lynch of the University of California San Francisco School of Pharmacy.
Individual Patient Choice
It’s easy to see medication nonadherence as a patient-level problem. A patient who isn’t taking their medication may be viewed as having made an individual choice.
Yet patients who decide they simply won’t take their medication are rare, says Kelly A. Thompson-Brazill, director of the Georgetown University School of Nursing Adult-Gerontology Acute Care Nurse Practitioner Program. Rather, patients are more likely to stumble over a cause outside their own control.
“There are so many different things that underlie why someone may not be able to adhere to a medication regimen,” says Thompson-Brazill.
Problems Associated With Patient Nonadherence
The costs of patient nonadherence are high. A 2017 study, by Rachelle Louise Cutler et al. found that the annual cost of nonadherence for individual patients ranged from $949 to $44,190.
Perhaps unsurprisingly, many of these costs arise directly from adverse health effects associated with medication nonadherence. In a 2022 study, Eric K.P. Lee and fellow researchers analyzed 161 studies of patients with hypertension who were prescribed medication.
The researchers found that 27 to 40 percent of the patients whose data they reviewed had failed to adhere to their medication regimen. They also noted that “patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all-cause hospitalization, and all-cause mortality” at higher rates than patients that adhered to their medications.
Addressing Patient Nonadherence
A 2022 study in the Journal of Clinical Medicine by Sarah Mendorf, Tino Prell and Aline Schonenberg examined the reasons patients gave for failing to adhere to their epilepsy medication regimen. Within their study group, “the average nonadherence rate was nearly 50%,” for which patients reported many reasons. Researchers grouped these reasons into three categories: therapy-associated, patient-associated, and circumstance-related factors.
“The results suggest that interventions for improving adherence should incorporate all dimensions of nonadherence,” write Mendorf, Prell and Schonenberg.
Writing in Pharmaceutical Commerce, Nitin Raizada, Arindam De and Durgagauri Sabnis identify several opportunities for technology to help providers and pharmaceutical participants address patient nonadherence. Their recommendations include:
- Personalize approaches to nonadherence by leveraging AI and data-driven analyses. This patient-centered approach, based on patient-level data, can help providers and pharma participants identify and address nonadherence.
- Collaborate with other participants in healthcare. Physicians, pharmacists, payers, patients and other participants can collaborate to identify and address reasons for nonadherence. Such collaboration can often be achieved more easily in virtual environments than by gathering in-person.
- Engage patients. Pharmaceutical research and communications have long been focused on peer experts like physicians, on regulatory bodies, and on participants like payers. By engaging patients, these parties can provide necessary information and support to boost medication adherence.
- Embrace a data-centric approach. It’s difficult to know how adherence efforts are proceeding if you have no way to track their progress. A data-centric approach focused within a single comprehensive platform allows everyone involved in patient care to gain insight into the treatment and adherence process.
Patients fail to adhere to their medication regimens for countless reasons. To understand why a particular patient isn’t taking their medication as prescribed, providers and other healthcare participants need a clear understanding of that patient’s behaviors and hurdles.
Tools that allow patients, providers, pharmacies, payers and other participants to collaborate on a single platform boost the chances of identifying a patient’s reasons for nonadherence — and addressing them before the consequences become dire.
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