Medication Nonadherence: Finding Solutions to a Costly Medical Problem

Harold Gottlieb, PhD

In This Article

Why Nonadherence?

Many factors are involved in patient nonadherence -- factors related to the characteristics of the disease, medication side effects, duration of treatment, frequency of expected intake, complexity of treatment, and severity of the disease. It has been demonstrated, for example, that people are less likely to continue their medication regimen over long periods and are less likely to be adherent when the daily doses increase from 1 pill to 4 pills.[7] In a study of patients who had seizures, those who were required to take only 1 pill a day showed 81% adherence rates, those who were required to take 3 pills a day adhered 77% of the time, and those who were required to take 4 doses a day showed adherence rates of 39%. To help prevent this problem of nonadherence in a multipill regimen, pills to be taken once a day should be prescribed for ingestion early in the morning, those prescribed twice a day can be scheduled to be given early in the morning and late at night, and those prescribed 3 times a day can be taken after each meal. Schedules calling for medication to be taken 4 or more times a day create an unnatural division of the day for most people, increasing the possibility of nonadherence.

For the most part, patients try to please their physicians. They typically give the impression, often convincingly, that they have been following or intend to follow the physician's medication orders. However, a patient soon forgets much of what he has been told by a physician and a pharmacist. Moreover, patients tend to remember what they are told first, what they consider most important, and what will have the least impact on their daily lives.

Highly anxious patients forget more of what they are told than less anxious patients. And if the information is consistent with previously held beliefs about the disease and about what the medication can and cannot do, the patient is more likely to adhere to the medication regimen. In addition, patients who write down what the doctor says are more likely to remember their medication instructions than patients who do not.[8]

Studies reported that 40% to 60% of patients could not correctly report what their physicians expected of them 10 to 80 minutes after they were provided with the information.[9,10] Yet another study reported that over 60% of the patients interviewed immediately after the visit with their doctors had misunderstood the directions regarding prescribed medications.[11]


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