Adherence can be broadly defined as a patient’s ability to accurately follow a prescribed treatment regimen. Medication adherence has been called America’s “other drug problem.” Nonadherence can lead to disease progression, disease complications, reduced functional abilities, and preventable deaths. Studies have shown that approximately 50% of patients do not take their chronic medications as prescribed. Nonadherence can include delaying or not filling a prescription, skipping doses, splitting pills, or stopping a medication early. Poor medication adherence or nonadherence can be either intentional or unintentional. Nationally, nonadherence costs the United States healthcare system an estimated $100 to $289 billion annually.
Adherence Barrier : Cost
There are several common barriers to medication adherence. The inability to pay for medications being the most prevalent in the United States, difficulty keeping up with multiple medications and complex dosing schedules, disbelief that a treatment is necessary or helping, and confusion about how and when to take the medication all contribute to patients not adhering to their prescriptions. As former Surgeon General C. Everett Koop said, “Drugs don’t work if patients don’t take them.” Patients can turn to NeedyMeds, a leading organization in helping people afford their medications and other healthcare expenses.
“Drugs don’t work if people don’t take them.”— C. Everett Koop, 1985
Across the board, the cost of prescription drugs rose 3% year-over-year from December 2018 to 2019, according to the Bureau of Labor Statistics’ Consumer Price Index. Based on data from the Kaiser Family Foundation, 29% of American adults report not taking their medicines as prescribed at some point in the past year because of the cost. This includes 19% who report that they haven’t filled a prescription, 18% who took an over-the-counter drug instead, and 10% who say they have cut pills in half or skipped a dose. As many as 29% of those reported not taking their medicines as prescribed say their condition has gotten worse as a result of not taking their prescription as recommended.
Adherence Barrier : Complicated Drug Regimen
Patients with multiple chronic conditions often take more prescriptions and over-the-counter medicines, are seen by different prescribers, and often grapple with taking complex combinations of different medicines correctly. Nearly 70% of Americans are on at least one prescription drug, and more than half take two, Mayo Clinic researchers say. An estimated 20% of Americans take five or more prescriptions. A majority of patients with multiple chronic conditions are elderly and/or on Medicaid, compounding issues related to medication adherence.
Adherence Barrier : Polypharmacy
Polypharmacy is the use of multiple medications, typically five or more. Polypharmacy is most common among older adults (aged 65+), people of all ages with multiple chronic conditions, or adults with intellectual disabilities. It may be hard for you or your caregiver to manage the timing or dosages of multiple medications. It’s also difficult for doctors to monitor the effects of the medications. The more medications you take, the more likely problems are to occur. It’s easier to make mistakes when trying to manage several different drugs, potentially leading to unintentional nonadherence.
Adherence Barrier : Pharmacophobia
Pharmacophobia is the fear of medication or other pharmacological treatments. A medication phobia can also present in parents who are concerned about giving medications to their children, fearing that a medicine may do more harm than good. Sometimes patients mistakenly associate symptoms of an acute illness with side effects from prescribed medications, or can be skeptical of a treatment’s effectiveness or necessity. Pharmacophobia can lead to lasting problems with medication adherence, through fear or lack of understanding.
Adherence Barrier : Education
Health literacy plays a vital role in patients’ understanding of their prescribed medication instructions. Skepticism and pharmacophobia (fear of medication or pharmacological treatments) can lead patients to believe a prescription isn’t necessary or may be harmful. A distrust of doctors or a belief in anti-science misinformation can lead to poorer health outcomes. Health literacy illustrates why talking about your medicines with your doctor is so important. Healthcare providers can do a lot to ensure their patients are not confused, and patients should not feel hesitant to ask questions if there is something they don’t understand.
Adherence Barrier : Demographics
Gender differences, age, as well as cultural and religious differences also play a role in medication adherence. Patients might not trust their healthcare providers. They may even have anti-science beliefs rooted in their cultural backgrounds. This can affect a person’s health, approaches to self-care, and the types of treatments they prefer. Understanding cultural perspectives is paramount to the patient’s likelihood of following medical advice.
To overcome these barriers, read here.