Medication non-adherence is a common and unfortunate reality in healthcare. Research has proven time and time again that despite intervention efforts, up to 50% of patients fail to take their medications as prescribed.
Far too often, this results in unnecessary trips to the emergency room, extended hospital stays and even death. In addition to causing at least 100,000 preventable deaths per year, non-adherence also leads to billions of dollars in avoidable healthcare costs annually.
Although the clinical and financial benefits of improving medication adherence are clear, successfully doing so requires pharmacists, prescribers, and caregivers to develop an understanding of why patients aren’t taking their medications. Is it intentional, or accidental? Will it require a tricky behavioral change, or can it be easily resolved? Are there specific patient trends that would help improve an individual’s adherence?
Let’s take a look at six common reasons why medication non-adherence occurs:
1. Memory and Forgetfulness
“Did I take my medication this morning? I can’t remember—I’ll just wait until tomorrow in case I already took it.”
Forgetfulness is very human—but it’s also a leading cause of medication non-adherence, and not just in older patients. Although the elderly and those receiving memory care are certainly at higher risk of being non-adherent due to forgetfulness, it is even more common for patients to forget simply because they’re distracted and inattentive. In some cases, this kind of mistake can even lead to an argument if a pharmacist reaches out to address non-adherence and the patient feels it is in error.
2. Denial and Unwillingness
“I’m not taking this stupid drug anymore. I don’t even need it — I’m as healthy as can be!”
Most of us have at least one relative who thinks they’re a doctor—or at least that they know better than one. Denial that a medication works—or that it’s even needed at all—and a general unwillingness to adhere to prescribed treatment plans are common causes of medication non-adherence. For example, a patient may not believe they even have the condition being treated. Others may recognize the value, but still be unwilling to adhere because they take too many other medications and are afraid of the possible issues of taking anything else.
3. Cost and Access Concerns
“This prescription is way too expensive, even with my insurance! I really can’t afford to be on it anymore.”
Cost continues to be a major barrier to adherence. In fact, the high cost of prescription medications can even lead to patients never filling them in the first place. Both uninsured patients and those with high deductible insurance plans cite cost as an obstacle that prevents them from remaining adherent. Drug access is also a potential cause, particularly for elderly patients who no longer drive, or busy, working parents who simply don’t have enough time in the day to make it to the pharmacy. Plus, people have different perceptions of mail order; some patients prefer it, whereas others do not because they want to develop a relationship with their pharmacist.
4. Mental Health Challenges
“I don’t feel good enough to take my meds today. I’m just staying in bed…”
Depression and other mental health struggles also play a role in non-adherence. For example, a recent study on adherence to dialysis revealed that patients who have never felt a depressive symptom skipped treatment half as often as patients with depression. Additionally, when patients are specifically non-adherent to mental health medications such as antidepressants, adherence typically declines across all medications.
5. Adverse Side Effects
“Forget the blood pressure medicine … it makes me feel too tired and loopy to work, and it makes my stomach hurt.”
Physical side effects are a significant contributor to non-adherence. Side effects and adverse reactions are an unpleasant possibility with most medications, and for some patients, fear alone is enough to keep them from taking their medication as prescribed. Although some patients are non-adherent because they’re frightened of potential side effects, others fail to comply because they’re already experiencing them.
6. Poor Health Literacy
“Does ‘take by mouth twice daily’ mean I take my pills at the same time, or separated by morning and night?”
Poor or lacking health literacy and communication gaps can also cause non-adherence. Medical terminology is complex and unfamiliar to most patients—especially those with limited experience navigating healthcare. Prescriber instructions can also mean different things to different people, and can result in accidental non-adherence when patients think that they’re taking their medication correctly.
Non-Adherence: Identifying the Root Cause to Find the Best Solution
Identifying the root cause for medication non-adherence is the first step to addressing it. A true understanding of the psychology behind medication non-adherence—coupled with the support of modern technology that helps predict trends and reasons for non-adherence—can make all the difference in increasing adherence rates, reducing costs, and improving outcomes.
About the Author
Dr. Linda Schultz
Dr. Linda Schultz is a results-oriented Healthcare Pharmacy Executive who excels at leading transformational, top-notch, interdisciplinary healthcare teams to create and execute outcomes driven clinical operations and account management initiatives. Dynamic and knowledgeable in all healthcare business segments, most passionately within the complex Medicare, Duals and Medicaid markets, she is an accomplished, creative motivator and driver of innovative quality and cost of care pharmacy interventions. Dr. Schultz is currently VP, Customer Success at AllazoHealth, a cutting-edge, healthcare artificial intelligence company. Prior to her leadership role at Allazo, Linda founded and led RxHorizons, LLC., an international healthcare consulting group. Her expertise stems from over 25 years of experience within the Managed Care industry, with a focus on leading, strategizing, developing and implementing pharmacy benefit management activities within national PBMs and health plans.