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Causes of Medication Non Adherence and How Doctors Can Help Patients

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Consider these statistics: In the United States, nearly 4 million prescriptions are written annually, according to a Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report. Studies referenced in an Annals of Internal Medicine article indicate that 20-30% of medication prescriptions are never filled and approximately 50% of medications for chronic disease are not taken as prescribed due to many different factors.

Such failed medication adherence has considerable health consequences. The Annals of Internal Medicine article notes that lack of adherence is estimated to cause approximately 125,000 deaths and at least 10% of hospitalizations annually, and a significant increase in morbidity and mortality. Medication nonadherence has been estimated to cost the U.S. health care system $100 billion to $300 billion annually, according to a Public Health Reports article.

4 Steps Doctors Can Take to Help Improve Patient Medication Adherence

With so much at stake, it is imperative that physicians work to help ensure patients fill their prescriptions and take these medications as directed. Here are four steps doctors can follow to support these objectives.

1. Understand the Causes of Medication Nonadherence 

To effectively help patients, physicians should learn about and understand the barriers to adherence. The American Heart Association identifies the following as reasons why people do not take medications as directed:

  • forgetfulness;
  • questioning of a medication's effectiveness;
  • mistrust of prescriber;
  • fear of side effects;
  • absence of symptoms; and
  • costs

Other causes include difficulty managing multiple medications, not understanding the purpose of taking a medication, and poor health literacy.

These causes can be broken down into two categories: unintentional non-adherence, which is when patients want to follow treatment but are prevented from doing so by obstacles out of their control, and intentional non-adherence, which is when patients choose not to follow treatment advice.

2. Focus on Education

Several of the reasons for both types of nonadherence referenced are related to patients not understanding and/or appreciating the importance of taking their prescriptions. In the Public Health Reports article referenced earlier, author Dr. Regina Benjamin notes that proper medication adherence should start with conversations between physicians and patients. "Make sure your patients know how to take their medication. Have them repeat the directions to you before they leave. Also, let them know why they are taking the meds and what to expect."

After each appointment, consider providing patients with a document listing their current prescriptions, providing instructions for each medication, and identifying any changes made to treatment. You may want to consider sharing this resource in paper and electronic format, so patients have multiple means of reviewing the information, and provide the resource to a caregiver, if requested. Also include instructions for how patients and caregivers can ask questions about any information included in the document and receive a new copy of the document if the original is lost.

3. Don't Assume Adherence

Considering the high percentage of patients who do not take their medications as described, do not to go into appointments and discussions with patients assuming adherence is occurring. This could put a patient's wellbeing at risk if a new prescription is issued or existing therapy changed based on the belief that the patient's current symptoms reflect the effects of the current regimen when, in fact, the patient is not taking medications as instructed.

Before moving ahead with any change in medications, review the regimen and ask if the patient is following it exactly as instructed. Explain the importance of honesty in the patient's answers. During these discussions, try to create a blame-free environment. A Clinical Diabetes article shares the following as examples of nonjudgmental questions health care professionals can ask patients to help assess medication adherence:

  • These medications you are prescribed are difficult to take every day. How often do you skip one?
  • You take quite a few medications. How many of these do you take?
  • Most people do not take all their medications every day. How about you?
  • Have you stopped taking any of your medications when you feel well?
  • Are you worried about any side effects?
  • When was the last time you took drug A? Drug B?

4. Come Prepared with Solutions

If you determine that a patient is not following their medication regimen, you will want to work to determine the causes. You should also be prepared with solutions to help address those obstacles. You don't want a patient leaving your organization facing the same barriers to adherence without some assistance to overcome them.

You will want a plan for helping patients who are challenged to pay for their medications, struggle with memory, and lack the health literacy to follow instructions, for example. If you provide a patient with support intended to improve adherence, follow up to try to verify if the patient took advantage of the support and determine its effectiveness. Be prepared to provide additional resources if the patient indicates continued struggles with adherence.

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