Medication "Adherence"

Only 50 % of Patients Use their Medications as Prescribed

I never assume patients use their medications in the exact way that we reviewed at the appointment. Some patients do, of course, but some don’t.

It has been estimated in various studies that up to 50 % of patients don’t use their medications as prescribed (This is of course one of the reasons that real world medication effectiveness is often less than clinical trial data).

Sometimes I’m the entire reason the patient does not use the medication properly, sometimes the patient has his or her own reason(s) and sometimes nobody really fully knows why it is that the medication is not used as often as it should.

Patients don’t want or like to feel judged or blamed for suboptimal medication use and so - not surprisingly - patients don’t always give an accurate account of their medication use. Normalizing suboptimal use by the practitioner can be helpful. I might say something like “many of my patients find it difficult to use this medication in the manner we spoke about - do you find yourself feeling the same way?” or “It’s pretty normal to forget- how many times in a week might you forget?”

The stigma associated with the topic has prompted the entire medical field to move away from referring to the subject as patient “compliance” and more towards “adherence.”

A variety of reasons exist including physician communication barriers, drug routines that are way too complex and way too time consuming, multiple practitioners or family members giving opinions, limited appointment times to have questions answered, language barriers, literacy issues, fear of adverse events, payment/insurance issues, lack of transportation to pharmacies or appointments, pharmacy errors, patient anxiety, depression, domestic violence, personal and religious beliefs, lack of support systems, personal health issues and limitations… and more.

Addressing barriers that impact adherence can improve patient medication use. The barriers are different for different patients and it may take some time and the building of a trusting relationship to fully understand all the issues.

Reference

Brown MT and Bussell. Medication Adherence: WHO Cares? Mayo Clin Proc. 2011 Apr; 86(4): 304–314.