Medication non compliance (nonadherence) with a physician’s therapeutic plan is a major problem in healthcare. It can lead to readmissions, increased healthcare costs and poor outcomes. This is a multi-factorial problem. Solving it requires a personalized solution for each patient. The first step is to understand the underlying reasons for the behavior. Medication non compliance rates range from 30% to 60%, and the calculators suggested below help to identify the contributing factors.
- Risk of Noncompliance in Use of Medications
- Factors Affecting Compliance with Therapy for Psoriasis
Never Start and Early Discontinuation
Some patients never start a therapy that has been prescribed, while other start only to stop shortly afterwards. These patients may not believe in the doctor, the diagnosis or that the drug does any good. This is particularly true in preventive therapies for a patient who does not feel sick, such as a patient with hypertension or prediabetes.
- Predictors for a Patient Filling the First Prescription (“First-Fill”)
- Early Discontinuation of Therapy
- Factors Affecting Adherence to Medications for Prevention of Type 2 Diabetes
Bothersome Side Effects
Some people stop because of bothersome side effects. The patient may feel worse after starting therapy than before. This can arise when there is a breakdown in communication with the clinician, preventing a switch to a therapy that may be better tolerated.
- Predictors for Tamoxifen Discontinuation in an Older Woman with Estrogen-Receptor Positive Breast Cancer
- Model for Predicting the Adherence Rate of a Renal Transplant Recipient to Immunosuppressant Therapy
Thinks No Longer Needed
Some people take medications for a longer period but don’t think that therapy is working or that it is needed anymore. They may start taking the drugs intermittently or not at all. This may reflect not being educated about why the therapy is necessary, or wishful thinking on the part of the patient.
- Rating of Medication Influences (ROMI) Scale for Compliance with Drug Therapy in Schizophrenia compliance
- Predictors for a Woman with Osteoporosis Showing Low Adherence to Bone Protective Medications
- Factors Identified Affecting Adherence in a Patient with Chronic Obstructive Pulmonary Disease (COPD)
Personality Disorder
Some patients who are being treated for a communicable disease may decide that they are not going to take a drug. The fact that this places others at jeopardy does not bother them at all. Substance abuse or antisocial personality disorder may underlie this behavior.
Tired of Taking the Drugs
Some patients, especially those on complex regimens, feel that therapy is a burden. This can be a problem for a patient who sees multiple physicians and is taking multiple medicines at different times of the day. If no one has done a drug review then no one may be aware of what the patient is experiencing.
- Treatment Fatigue
- Method for Grading Adherence to Antiretroviral Therapy
Other Reasons for Noncompliance
Other reasons why a patient may not follow a therapeutic plan include:
(1) The medicine costs too much.
(2) The person is forgetful or demented and does not have a caregiver.
(3) The patient has a visual impairment and cannot identify the medications to take them.
(4) The person has had a break in the usual routine and just stopped taking the medicine.
(5) The patient cannot take a medicine for some reason such as an inability to swallow.
An Ounce of Prevention
Some reasons for noncompliance are easily overcome but others may take some work.
Some basic steps to avoid noncompliance:
(1) Develop a trusting relationship with the patient.
(2) Do not prescribe unless a drug is necessary.
(3) Educate the patient about why the medicine is necessary and what side effects can occur.
(4) Screen for noncompliance in follow-up visits. This may take some digging, since some patients will not admit that they are not following instructions.
(5) Conduct a periodic drug review, just to see what medicines that the patient is taking.
(6) Have some means of communication available to the patient.
- Findings Suggesting Noncompliance in the Use of Medications
There are a variety of ways to verify a patient’s response. A compliant patient should be familiar with the medicines being taken, and there should be pharmacy records of the prescription being filled.
- The Pill Identification Test for Assessing Compliance with Therapy
Dealing with Noncompliance
There are several ways to address noncompliance once it has been identified. The patient’s entire drug regimen needs to be reviewed and simplified. Any barriers that can be removed should be.
Engaging and re-educating the patient about the disease being treated and the reasons for therapy can improve compliance.
Sometimes a simple break (drug holiday) can restore flagging morale.
- Method for Improving Adherence in HIV-Infected Patients
- Enablers and Incentives in a Patient-Centered Treatment Strategy to Increase Patient Compliance with a Long-Term Therapeutic Regimen
In some circumstances a simple solution may not be enough. If the medicine is essential or the patient poses a risk to others, then it may be necessary to physically observe the person taking the medicine.
- Directly Observed Therapy (DOT)
Take-Home Messages
Nonadherence is a significant problem in healthcare. Finding the causes and addressing the issues can reduce or eliminate noncompliance. Using medical algorithms can be part of the solution.
If you interested in seeing more medical calculators on nonadherence, see our Medal Pack on Therapeutic Compliance.
