Everyone knows the phrase, “Take two pills and call me in the morning.” However, for many patients, this task is easier said than done. There are many reasons for medication noncompliance, and the challenge for physicians is identifying which one (or ones) apply to each patient. For example, a patient may lack access to transportation. When it’s time to pick up his refill, several weeks or more might elapse before he can get a ride to the pharmacy, resulting in dangerous medication gaps. Another patient may forget to take her medications because she has dementia. It isn’t until a loved one sees that she hasn’t taken her prescription in weeks or even months that the problem is detected. There are a whole host of reasons for medication noncompliance, many of which are related to social determinants of health, with some experts arguing that the problem has reached epidemic proportions.
The good news is that by addressing patient-specific compliance barriers, physicians can improve medication compliance and outcomes, both of which, in turn, lower costs under value-based payments. Consider the following seven reasons for noncompliance of medication and what providers can do to address these barriers:
- Poor doctor-patient relationships. Let’s face it. Physicians don’t have a lot of time with patients, and they need to make the time they do have worthwhile. This includes a frank and specific conversation about medication compliance. For example, instead of asking patients if they have taken their medications, physicians need to dig deeper by asking these questions instead:
- “During the last week, how many days have you missed taking any of your medications?”
- “During the last week, what percentage of your medications have you taken?”
- “What gets in the way of taking your medications on some days?”
Foster a blame-free environment, and make sure patients know the clinical team is there to help them—not point fingers.
- Forgetfulness. Patients lead busy lives and can sometimes simply forget to take their medications. Others may have cognitive disabilities or mental illnesses that get in the way of medication compliance. Address this challenge by encouraging patients to use pill organizers, creating a pill card, simplifying medication regimens (i.e., by prescribing combination medications), or linking medication regimens to daily habits (i.e., taking medications directly after brushing one’s teeth in the morning). Another solution is to call patients after their appointment to see whether they have any questions and schedule a follow-up visit to ensure medication compliance. Furthermore, there are several mobile apps that patients can use to help remember to take their medication. Platforms such as HealthPrize even use gamification to remind and motivate patients to take their medications as prescribed.
- Patient’s lack of understanding. Noncompliance often occurs when patients don’t understand why they’re taking a certain medication. Help them understand the purpose of the medication and why and how it will benefit them. Also, describe potential side effects. For example, if patients know a medication may cause drowsiness, they can take it at night rather than during the day. Likewise, if they know a medication may cause nausea, they can plan ahead to take it with food. Finally, ensure patients understand that medication compliance is critical—even when they aren’t experiencing any symptoms. Patients often make the mistake of assuming they don’t need a medication because they feel better and don’t understand the importance of ongoing compliance. Fifty percent of patients prescribed statin drugs to control cholesterol, for example, discontinue their use after one year. Skipping one or more doses can be extremely harmful to one’s health. Providing patients with educational pamphlets and other resources can be incredibly helpful in terms of overcoming this challenge. Finally, always ask patients whether they have questions or concerns. Let them know that you’re a source of support and guidance.
- Cultural or religious biases. There’s poorer medication compliance in less acculturated patients. Likewise, some patients may not take their medication because they feel that God controls their health and illness. All providers and staff should undergo cultural competency and implicit bias training to provide a context for understanding these barriers and potentially overcoming them.
- Cost. As the cost of prescription drugs continues to increase with no end in sight, it’s not surprising that many patients don’t take their medications because they simply can’t afford them. For some patients, choosing to take their medication means forgoing groceries and other basic necessities. Physicians can help address this barrier by prescribing generic drugs as well as pointing patients toward coupons, vouchers, patient assistance programs, and other websites such as: NeedyMeds, Medicine Assistance Tool, and GoodRx.
- Physical impairments. Sometimes a patient’s physical impairments can cause medication noncompliance. For example, a patient may have a visual impairment that affects his ability to read written instructions. Another patient may have a hearing impairment that affects her ability to hear the physician’s verbal instructions for taking a medication. Impaired mobility and dexterity in the elderly can make it difficult for a patient to open a pill bottle. Physicians can overcome these barriers by providing large print instructions and educational materials. They can also encourage patients to bring a friend or family member with them to the appointment to provide support.
- Lack of access to transportation. Research shows that transportation barriers impact access to pharmacies and thus medication compliance. Nearly one out of every four prescriptions for children within zip codes with high poverty and low-vehicle access are not filled. Pointing patients toward medication home delivery services may be helpful. Some payers are even partnering with rideshare services to help patients living in “transportation deserts” go to the pharmacy to pick up prescriptions.
By addressing these main reasons for medication noncompliance, physicians can help patients take their medications as prescribed. It takes a team to make this work. Patients and their providers must work together to overcome barriers and inspire change that improves outcomes.