Medication Nonadherence: Finding Solutions to a Costly Medical Problem

Harold Gottlieb, PhD

Disclosures
In This Article

Abstract and Introduction

This article explores factors that have an impact on patient medication nonadherence. It presents a number of strategies to enhance adherence and outlines personality characteristics of noncompliant patients, characteristics of diseases that affect nonadherence, and aspects of the health care setting that may affect patient nonadherence.

As the population continues to age and cost-containment pressures increase, the health care industry will be challenged to find ways to empower patients to play a greater role in the management of their illnesses. One way in which patients will be better able to manage their illnesses is by adhering to their medication regimens.

Medications are dispensed with the expectation that they will be taken exactly as prescribed. However, most patients do not follow their doctors' orders. Excuses take many forms: "The medication was too expensive," "If 1 pill is good, then 2 pills should be twice as good," or "I didn't understand the directions on the label."

Medication nonadherence can have negative consequences for the patient, the provider, the physician, and even the medical researchers who are working to establish the value of the medication for the target population.

Depending on the characteristics of the condition, the treatment, the patient, and the setting, estimates of medication nonadherence rates typically range from 30% to 60%, with the nonadherence percentage being greatest when the patients are symptom-free.[1] In an era when efficacious drug therapies exist or are being developed at a rapid rate, it is discouraging that one half of the patients for whom appropriate medication is prescribed fail to receive the full benefits because of inadequate adherence to treatment.[2] One study showed that 77% of patients demonstrated degrees of compliance with their medication regimen when the treatment was designed to cure a disease and only 63% of patients complied when treatment was aimed at prevention. However, when medication was to be taken over a long period, compliance rates dropped dramatically to approximately 50% for either prevention or cure.[3]

Studies show that 20% to 80% of patients make errors in taking medication and that 20% to 60% stop taking medications before being instructed to do so.[1,3] With older populations, the literature concerning adherence reports that compliance rates range roughly from 38% to 57%, with an average rate of less than 45%.[3,4] Patients forget to take their medications, creatively alter their medications, engage in unendorsed polypharmacy, mix their medications, and take medications in combinations that may have dire synergistic interaction effects, such as dizziness and confusion.

Medication adherence presents a particularly complex issue for the elderly patient.[5] The relationship between adherence and age depends on the specific illness, the treatment time frame, medication regimen, and the cognitive/affective status of the patient. For the elderly patient, medication issues and/or abuses may also result in accidents, such as a fall that causes a hip fracture. Furthermore, an elderly patient could forget that he or she had already taken the prescribed amount of medication and unwittingly overdose.[5]

The Minnesota Colon Cancer Control Study found a linear relationship between age and compliance with regard to colorectal cancer screening.[6] In this large, long-term, longitudinal study of men and women, the best compliers were approximately 70 years old; the worst compliers were patients younger than 55 years and those older than 80 years.

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