November 6, 2015

Eight Reasons for Drug Non Adherence

Drug non adherence (or non compliance) is a topic few people want to talk about, except doctors who rail about patients that do not take their medications. In my blog here, I summarized it this way - I have an easy answer for them and I don't need over 30 pages to tell doctors the problem. Learn how to communicate with patients rather than ram medications down our throat. Most of the time, these doctors just hand the patient a fist full of prescriptions with no explanation and expect the patient to fill each prescription and take the medication as directed.

Now we have an article by the American Medical Association listing eight reasons patients don't take their medications. Data show about one-quarter of new prescriptions are never filled, and patients do not take their medications about 50 percent of the time. Most non adherence is intentional: patients make a rational decision not to take their medicine based on their knowledge, experience and beliefs.

The top eight reasons for intentional non adherence are:
  1. Fear. Patients may be frightened of potential side effects. They may have witnessed side effects experienced by someone else that was taking the same or a similar medication and believe the medication caused the problems.

  2. Cost. Patients may not fill medications in the first place or ration what they do fill to extend their supply.
  3. Misunderstanding. Patients may not understand the need for the medicine, the nature of the side effects or the time it will take to see results. This is particularly true for patients with chronic illness, because taking a medication every day to reduce the risk of something bad happening can be confusing. Failure to see immediate improvement may lead to premature discontinuation.
  4. Too many medications. The greater the number of different medicines prescribed and the higher the dosing frequency, the more likely a patient is to be non adherent.
  5. Lack of symptoms. Patients who don’t feel any differently when they start or stop their medicine might see no reason to take it.
  6. Worry. Concerns about becoming dependent on a medicine also lead to non adherence.
  7. Depression. Patients who are depressed are less likely to take their medications as prescribed.

  8. Mistrust. Patients may be suspicious of their doctor’s motives for prescribing certain medications because of recent news coverage of marketing efforts by pharmaceutical companies influencing physician prescribing patterns.

Unfortunately, the AMA is not concerned about communication with the patients and only interested in improving medication adherence. They have a free online module that includes practical strategies and tools that doctors can implement. The module also includes information about how to get support for intervention implementation, and it offers continuing medical education credit.

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