Strategies for Managing Medication Non-Adherence

In our world of ever-expanding pharmacologic options, we continue to see patients whose treatment may be compromised by non-adherence to our prescribed medication regimens. 

Estimates of the prevalence of medication non-adherence for patients taking long-term medication are typically around 50%. There are a number of factors that may contribute to differential levels of risk of non-adherence, including such things as: 

• Duration of recommended therapy
• Patient age
• Cost of the medication
• Reason for the use of the medication (treatment of a condition vs. prevention)
• Complexity of the treatment regimen/frequency of dosing
• Severity of the condition being treated 

Often, patients leave the office with an incomplete understanding or misunderstanding of the rationale for the use of the medication as well as of the instructions. One study demonstrated that 60% of patients who were interviewed immediately following their appointment misunderstood the directions for taking the medication. 

Also, patients generally want to please their health care providers. They may feel inhibited in reporting problems such as side effects, lack of efficacy, or high costs, or in disclosing that they have reduced or stopped the medication. 

Many electronic health record systems that include electronic prescribing functionality allow clinicians to easily review a patient’s prescription history, and some allow the clinician to obtain actual prescription fill data that can allow the clinician to monitor the patient’s use of the medication.  

So what can the individual clinician do to help minimize this problem?

1. A good starting point is to provide the patient with a clear, non-jargon explanation of the specific improvement that is expected as a result of the use of the medication, as well as an explanation of the side effects that could be experienced by the patient.

2. This verbal explanation should be accompanied by clearly written instructions.  

3. It is also helpful to let the patient know that there are other options available if the recommended treatment doesn’t work, isn’t affordable, or isn’t well tolerated. 

Working collaboratively with patients to treat their conditions and meet their health goals is an approach that can help to reduce the problem of medication non-adherence. 

How do you address the issue of treatment non-adherence in your practice?

Chris Bojrab, MD, is the president of Indiana Health Group, the largest multidisciplinary behavioral health private practice in Indiana, established in 1987. He is a board certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association who treats child, adolescent, adult, and geriatric patients. His areas of interest include psychopharmacology, sleep disorders, and gambling addiction. For more information and disclosures, visit  www.chrisbojrabmd.com

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.