Studies suggest that about 50% of people living with chronic illness stop taking their prescribed medicines within 12 months. Furthermore, up to 30% of prescriptions are never filled at all (Cutler et al. 2019).
Not only does medicine non-adherence have clinical consequences such as disease progression, morbidity and mortality - but it also results in higher costs and increased use of healthcare resources (Cutler et al. 2019).
Medication adherence refers to ‘the extent to which a patient’s medication-taking behaviour and/or execution of lifestyle changes corresponds with agreed recommendations from a healthcare provider’ (FIP 2018).
This includes:
(Gast & Mathes 2019; FIP 2018)
Optimal therapeutic efficacy generally requires an adherence rate of 80% (Kim et al. 2018).
Medication non-adherence, on the other hand, is when a patient does not follow the medicine regimen they have been prescribed.
This might mean:
(FIP 2018)
There are two types of non-adherence:
(Usherwood 2017)
There are a variety of factors that may contribute to both intentional and unintentional non-adherence. These include:
| Intentional Non-Adherence Factors | Unintentional Non-Adherence Factors |
|---|---|
| Perceived necessity of treatment | The complexity of the treatment regimen, especially if the patient has been prescribed medicines for multiple comorbidities |
| Safety concerns | Cognitive impairment |
| Acceptance of disease chronicity | Cost - 7.6% of people delay or never fill their prescription due to cost |
| Beliefs about the effectiveness of treatment | Practical difficulties (e.g. difficulty opening medicine bottles or swallowing tablets) |
| How easy the treatment is to use | Older age, which may cause a decline in memory, mobility and manual dexterity |
| Satisfaction with treatment | Poor eyesight, which makes instructions and labels more difficult to read |
| Opinions of family and friends | Confusion |
| Fear of adverse effects | Not knowing how to use equipment properly (e.g. asthma inhalers) |
| Experience of adverse effects |
(Usherwood 2017; ACSQHC 2020; FIP 2018)
Interventions used to target intentional non-adherence generally focus on patient education and discussion (Usherwood 2017).
Consultation with the patient upon dispensing a new or repeat prescription is an important way to provide this education - and is the pharmacist’s responsibility (FIP 2018).
This conversation might involve:
(FIP 2018)
As well as ensuring the patient is appropriately educated about their treatment regimen, this conversation will facilitate partnership and shared decision-making - which, in turn, can also encourage adherence (FIP 2018).
Strategies to improve unintentional non-adherence might focus on removing barriers and improving the patient’s ability to follow their medicine regimen, for example:
(Usherwood 2017)
Sometimes, the patient may know which medicines to take and how to take them but forget to actually do so. In these cases, where the patient cannot be relied on to take their medicines on their own, medication prompting might be a useful strategy (Ministry of Health 2019; Care Inspectorate 2015).
Medication prompting involves reminding the patient of the time of day, and then asking them if they are going to take their medicines (Care Inspectorate 2015).
It’s important to remember that the patient needs to self-administer (Medicine Management 2014). They are still in control and can choose not to take their medicine even after being prompted, or can choose to take their medicine later (Care Inspectorate 2015).
Note that medication prompting does not involve:
(District 360 2023)
Question 1 of 3
Which one of the following is an example of intentional non-adherence?
Assign mandatory training and keep all your records in-one-place.
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