Patients often do not take their medications as prescribed or they discontinue them early.
Non-adherence to medications often associated with treatment failure, poor outcomes, and increased healthcare costs.
Adherence to a medication regimen is central to good patient outcomes.
Poor medication adherence is associated with increased with morbidity and mortality and may account for approximately 125,000 deaths and 10% of hospitalizations in the US annually.
Central to errors in the treatment decisions, poor health literacy, personal and community beliefs regarding medication effectiveness, and previous experience with pharmacologic therapies.
Effective physician/patient communication is linked to positive outcomes of care including patient satisfaction, health status, recall of information, and adherence.
Physician discussions help patients understand their illness and weigh the risks and benefits of treatment.
Drug nonadherence is characterized by never starting or failing to refill a medication, stopping the medication early without direction, or regularly not taking the medication as directed.
Poor adherence to prescribed medication is associated with reduced treatment benefits and can obscure the clinician’s assessment of therapeutic effectiveness.
Poor adherence to inhaled controller medications is common among patients with asthma and chronic obstructive pulmonary disease.
25% of first prescriptions for pulmonary inhaler medicatiins are not dispensed, and for ongoing treatment, adherence, when inhaler use is monitored averages only between 25 and 50% of the prescribed dose.
Poor inhaler adherence is associated with ineffective symptom control, increase exacerbations, and risk of death.
Poor adherence may be intentional, unintentional, or combination of both.
Among adults with chronic illnesses such as diabetes or hypertension, between 30 and 50% of medications are not taken as prescribed.
Nonadherence is thought to account for 30% to 50% of treatment failures
Nonadherence leads to worse medical treatment outcomes; higher, avoidable hospitalization rates; institutionalization for the frail elderly; and increased healthcare costs.
Physicians play an integral role in medication adherence, as physician trust is more important than treatment satisfaction in predicting adherence to prescribed therapy and overall satisfaction with care.
Physician trust correlates with acceptance of new medications, intention to follow physician instructions, perceived effectiveness of care, and improvements in self-reported health status.
Adherence is the key mediator between medical practice and patient outcomes.
There is a higher risk of nonadherence among patients whose physician communicates poorly than among patients whose physician communicates well, with the odds of patient adherence 2.26 times higher if a physician communicates well.
Nonadherence translates into more than 183 million medical visits that need not take place if strong interpersonal physician/patient communication occurs.
Communication contributes to a patient’s understanding of illness, risks and benefits of treatment.
Compliance, suggests a process in which dutiful patients passively follow the advice of their providers and is sometimes substituted with the word adherence as the trend moves toward patient-centered care.
Persistence is the duration of time from initiation to discontinuation of therapy.
Continuing to take any amount of the medication is consistent with the definition of persistence.
Patient/provider concordance is the extent to which patients and their providers agree on whether, when, and how a medication should be taken.
Nonadherence encompasses both intentional and unintentional behavior, that leads to either underuse or overuse of prescription medications.
Underuse includes:
Delay or not filling a prescription.
Not picking up a prescription
Skipping doses
Splitting pills
Stopping a medication early
Not refilling a prescription
Predictors of Medication Nonadherence.
Low literacy
Homelessness
Depression
Psychiatric disease
Substance abuse
Lower cognitive function
Forgetfulness
Anger, psychological stress, anxiety
Lack of insight into illness
Lack of belief in benefit of treatment
Belief medications are not important or are harmful
Complexity of medication regimen
Tired of taking medications
Inconvenience of medication regimen
Side effects or fear of medication side effects
Cost of medication
Barriers to access to care or medications
Inadequate follow-up or discharge planning
Missed appointments
Poor adherence to medical treatment is widespread.
Poor adherence to medical treatment associated with consequences of poor health outcomes and increased healthcare costs.
Nonadherence to medications is estimated to cause 125,000 deaths annually.
Overall, about 20% to 50% of patients are nonadherent to medical therapy.
People with chronic conditions only take about half of their prescribed medicine.
Adherence to treatment regimens for high blood pressures is estimated to be between 50 and 70 percent.
1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year.
Underuse of anticoagulant therapy for prevention of thromboembolism risk factors: younger age, male gender, low overall stroke risk, poor cognitive function, homelessness, higher educational attainment, employment and reluctant receptivity of medical information.
Overall satisfaction of care is not typically a determining factor in medication adherence.
Adherence drops when there are long waiting times at clinics or long time lapses between appointments.
Patients with psychiatric disabilities are less likely to be compliant
Nonadherence results in an economic burden of $100 to $300 billion per year.
Annually, nonadherence costs $2,000 per patient in physician visits.
The rate is expected to increase as the burden of chronic disease increases
Nonadherence accounts for 10% to 25% of hospital and nursing home admissions:
Nonadherence results in: 5.4 times increased risk of hospitalization, rehospitalization, or premature death for patients with high blood pressure.
2.5 times increased risk of hospitalization for patients with diabetes.
More than 40 percent of nursing home admissions.
Medication adherence requires the patient to believe there is a benefit to the medicine being prescribed and agree with instructions on how to take it.
The physician must discuss cost issues to insure the medication is obtained and that instructions are followed.
Medical professional adherence is 77% for short-term medications and 84% for long-term medications among doctors and nurses.
Promoting medication adherence by:
Simplifying drug regimens by adjusting timing, frequency, amount, and dosage.
Imparting knowledge.
Modify patient beliefs.
Modifying human behavior
Provide communication.
Provide trust
Evaluate adherence
Medications taken once-a-day are pref2241ed.
Recommend to take medications at same time of day.
Avoid prescribing medications with special requirements.
Encourage the use of medication organizers and alarms.
Adherence is enhanced when a patient understands their condition and benefits of treatment.
Provide clear instructions for all prescriptions.
Elicit patient input in treatment decisions.
Patients with higher education are more likely to want to be involved.
Improve scheduling appointments, ref2241als, refills.
Patients should be reminded to refill early.
Adherence to medication regimens is critical to patient outcomes but consistent adherence is hard to achieve.
Adherence to all medications decreases steadily with increasing number of drugs prescribed.
Depressions and dementia significantly lower drug adherence rates.