The Importance of Medication Adherence

Hippocrates exhorted every physician to “not only be prepared to do what is right himself, but also to make the patient, the attendants and externals cooperate.” Yet, 2,000 years after what is still considered the gold standard in medical ethics was written, physicians continue to struggle with implementing this part of the Hippocratic oath.

The complicated medical regimens of modern-day medicine do not help. They make it challenging for physicians to improve medication adherence and partner with their patients in doing the right thing when it comes to prescribed medications.

But improving compliance with a treatment regimen is critical. The CDC estimates that 60% of Americans have at least one chronic disease. Given that the treatment of chronic diseases commonly involves the long-term use of pharmacotherapy, medication compliance becomes vital. Thousands of medications have been developed to combat chronic conditions effectively, but patient adherence remains low. Estimates by the World Health Organization suggest that approximately 50% of patients with a chronic illness do not take their medications as prescribed.

Multiple factors influence medication-taking behaviors

Medication non-adherence is a complicated problem. Factors that contribute to poor medication adherence are varied and are related to patients, physicians, and healthcare systems.

Patient-related factors that can lead to poorer medication adherence include the cost of medications, the hassle of taking multiple medications or multiple doses, suboptimal patient education, a lack of involvement in the treatment decision-making process, and therapy-related factors. A great example is cardiovascular medications. For some patients, it comes down to “Do I pay my heating bill this month or fill my prescriptions?” For others, it is simply a lack of understanding. Many medications used to treat chronic illnesses don’t necessarily make the patient feel any better. So, while lipid-lowering therapy (statin therapy) can significantly reduce the risk of coronary artery disease and stroke, statin adherence may be low because statin medications don’t necessarily make a patient feel any different. The same is true for antihypertensive medication adherence and other drugs used to treat cardiovascular disease.

Factors related to physicians also influence medication compliance. Communication barriers such as language, poor communication about adverse outcomes when giving the initial prescription, prescription of complex medication regimens, and contradictory information from multiple physicians can all contribute to medication nonadherence.

Then there are factors related to the health care system. Limited access to care, limitations on office visit time, and lack of health information technology such as pharmacy refill records are all factors that influence medication-taking behavior.

Because the hurdles to improving medication adherence are complex and varied, the approach to improving adherence also needs to be multi-pronged.

The importance of medication adherence

It is estimated that in the U.S. alone, medication nonadherence leads to avoidable healthcare costs to the tune of $300 billion every year (10% of the total healthcare costs).

Many of the leading causes of death in the U.S., such as heart disease, cancer, stroke, Alzheimer’s disease, and diabetes, are hugely influenced by medication adherence and other health choices.

But there’s a general lack of awareness about the consequences of poor adherence. Many people diagnosed with chronic conditions like high blood pressure and diabetes don’t realize that they can save thousands of dollars in avoidable healthcare costs simply by following the prescribed medication regimen.

The consequences of poor medication adherence

Improving adherence rates for medications is critical because the consequences of poor medication adherence are alarming. In a patient who doesn’t take all their medications as prescribed, a chronic disease can progress, leading to premature death. Indeed, many chronic illnesses are progressive, and while medications are available to slow the progression, pharmacotherapy can’t work if the patient does not take the medication. By some estimates, 1 in 3 patients with chronic diseases never initiates a newly prescribed medication.

Higher medication adherence is also important to prevent life-threatening complications from chronic conditions. For instance, patients with high blood pressure who are not compliant with antihypertensive therapy can land up in the emergency room with acute coronary syndrome. There are thousands of emergency department visits every day for end-organ damage from untreated hypertension.

Promoting compliance with a prescribed medication or treatment regimen

The onus of increasing medication adherence falls on everyone - healthcare providers, patients, and the healthcare system. Physicians should undertake adherence measures such as:

Clearly communicating the importance of medication compliance.
Involving the patient in their health journey.
Involving caregivers in the treatment plan, especially for elderly patients.
Screening patients regularly to detect medication nonadherence early on.
Undertaking health education programs and community interventions to promote patient education and engagement.
Offering prescription discount cards and other payment programs to reduce costs.

My number one recommendation for good medication adherence by patients is to be honest with your healthcare providers. Tell them if you’re not taking a medication and why. For instance, if you have poor medication adherence due to concerns about affordability, your doctor or pharmacist may suggest a low-cost alternative. Or you could use a BuzzRx coupon for discounts on your medications. Other measures for improving medication adherence include:

Write down your doctor’s instructions for medication therapy if you think you might have trouble remembering.
Ask your doctor, nurse, or pharmacist about patient education resources if you want to learn more about your chronic illness or medications.
Incorporate medications into your routine, i.e., linking your medication dose to a daily activity like brushing your teeth.
Use pillboxes.
Use alarms or mobile apps designed to remind patients to take medication.

Last but not least, a healthcare system can bring down rates of medication non-adherence by improving access to care and reducing prices to make medications more accessible.

Medication adherence is not a straightforward problem, and there’s no magic pill to fix it. But if all parties work together, we can certainly improve poor adherence, and consequently, patient outcomes.

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