Medication Non-compliance / Non-adherence

Social and economic

• Financial status
• education level
• employment
• access to healthcare services

Cost of treatment

• High out-of-pocket costs for medications
• specialist consultations
• follow-up care costs

Health system related

• Characteristics of the health care provision
  • availability
  • accessibility
  • efficiency of health services
• Patient and prescriber interaction
  • Clear communication
  • mutual trust
  • shared decision-making
• Prescribers follow-up
  • assess patient adherence
  • monitor side effects
  • adjust treatment if necessary
  • Lack of follow-up can result in missed opportunities to reinforce the importance of medication adherence
• Multiple providers
  • multiple specialists or care providers may receive conflicting advice or redundant prescriptions

Condition related

• Characteristics of the Disease: Some diseases, such as those with variable symptoms, may cause patients to feel better and discontinue medication prematurely, as seen in conditions like hypertension.
• Severity: Patients may perceive their condition as not severe enough to warrant strict adherence, particularly if symptoms are mild or absent. On the other hand, patients with severe conditions may become overwhelmed by the complexity of their treatment regimen.
• Chronic vs. Acute: Adherence tends to be better with acute conditions, where the therapeutic outcome is immediate, compared to chronic diseases where the benefits of adherence are long-term and less tangible.

Patient related

• Patient’s View of Required Therapy: Patients’ beliefs and perceptions about their medications (e.g., perceived necessity or skepticism about effectiveness) play a critical role in adherence. Misinformation or fear of dependency can lead to intentional non-adherence.
• Cognitive Functioning: Cognitive impairments, such as those seen in elderly patients or those with mental health disorders, can hinder adherence due to forgetfulness or misunderstanding of the therapy.
• Health Literacy: Patients with low health literacy often struggle to comprehend prescription instructions, disease management plans, or the importance of adherence, leading to mistakes in taking medications.
• Motivation for Self-care: Lack of motivation due to depression, anxiety, or general apathy can result in patients neglecting their treatment. This is especially prevalent in chronic diseases that require long-term commitment.
• Social Support: Patients with strong social support networks, including family and friends, are more likely to adhere to medications. Conversely, isolation can decrease the likelihood of adherence due to lack of encouragement and assistance.

Therapy related

• Multiple Medications: Polypharmacy increases the complexity of medication regimens, making it harder for patients to adhere to therapy. It is common in elderly populations or those with multiple chronic conditions.
• Complexity of Therapy: Regimens that involve frequent dosing, multiple medications, or special handling requirements (e.g., refrigeration, injections) are more difficult to follow, increasing the risk of non-adherence.
• Adverse Drug Reactions: Side effects, even minor ones, often cause patients to discontinue therapy. The perception of risk versus benefit can be skewed, particularly if side effects are uncomfortable or unexpected.
• Duration of Therapy: Long-term or indefinite treatments can lead to “treatment fatigue,” where patients become weary of taking medications daily, particularly when symptom improvement is not immediately apparent.

Management

• Behavioural interventions
  • Cognitive–behavioural techniques and therapies focused on dysfunctional emotions, behaviours and cognitions with the aim to promote healthy lifestyles, and positive changes toward symptoms and treatment
  • Structured counselling sessions
• Medication Management Programs:
  • Pharmacist Involvement: Pharmacists can provide medication reviews, patient counseling, and help simplify regimens.
  • Continuous Monitoring: Electronic systems, such as medication reminder apps, or devices like Webster-packs (dose administration aids), can track adherence and provide timely reminders.
  • Webster Pack: A form of medication packaging that organizes doses by day and time, improving adherence by reducing confusion over when to take medications.
• Identify cost-cutting strategies
  • close the gap
• Address mental barriers and stigma
  • Many patients also face their own mental barriers or fears of stigma that keep them from taking their pills.
• • Stigma: Adolescents or other vulnerable groups may avoid taking medications in social settings due to the stigma associated with being ill or needing treatment. Offering alternative strategies or peer support can help mitigate these concerns.
  • Use motivational interviewing and coaching.
• Direct symptom, side effect management
  • Manageable Side Effects: Proactive management of side effects can prevent patients from discontinuing their medication. Dose adjustments, alternative therapies, or adjunct treatments to alleviate side effects may be necessary.
• Reduce Pill Burden: Simplifying treatment regimens by reducing the number of daily pills can significantly improve adherence.
  • De-prescribing: Evaluating the necessity of each medication and removing unnecessary drugs can reduce complexity and improve adherence.
• Selecting Simplified Therapy:
  • Fixed-dose Combination Drugs: Combining multiple active ingredients into one pill reduces the pill burden.
  • Long-acting Medications: Using medications with extended-release formulations or those that require less frequent dosing can enhance convenience. For example, switching from captopril (2-3 times daily) to lisinopril (once daily) for hypertension management improves adherence.
• Technology-based Interventions
  • Telemedicine and Remote Monitoring: Virtual follow-ups and remote monitoring of patient health metrics can enhance adherence, particularly for those who find it difficult to visit clinics regularly. Real-time data on blood pressure, glucose levels, or medication usage can alert providers when non-adherence is suspected.
  • Mobile Health Applications: Digital tools such as mobile apps can remind patients to take their medications, offer information on their treatment, and even provide virtual coaching and feedback. These apps often include adherence trackers, allowing patients to set goals and measure progress.
• Family and Community Involvement
  • Family Engagement: Family members can play a crucial role in reminding patients to take medications, monitoring their health, and offering emotional support. Involving family or caregivers in the treatment process can reinforce adherence.
  • Community Support Groups: Chronic illness support groups or patient advocacy organizations can provide peer support and education on the importance of adherence. These groups reduce isolation and offer shared experiences that encourage adherence.
• Personalizing Medication Adherence Plans
  • Personalized Medicine: Advances in pharmacogenomics allow for more personalized prescribing based on a patient’s genetic makeup. Tailoring therapy in this way may reduce side effects, improving both patient satisfaction and adherence.
  • Patient-Centered Care Plans: Adherence improves when treatment plans are individualized to fit a patient’s lifestyle, preferences, and values. Shared decision-making encourages patient involvement in developing a realistic and achievable medication regimen.