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We’ve Got An Adherence Problem: What Are We Doing About It?

By Dr. Tal Rapke, founder, ScalaMed.

According to a 2003 report by the World Health Organization (WHO) into medication adherence, about 50 percent of patients with chronic illness don’t take their medications as prescribed. This poor adherence to medication leads to wastage, disease progression, increased morbidity and death, increased burden on medical resources, and is estimated to cost approximately $100 billion per year.

A 2012 study published in the Annals of Internal Medicine recorded a lack of adherence to taking medication as the cause of almost 125,000 deaths in the US per year. The research found that 10 percent of admittances to hospital were as a consequence of non-adherence to prescribed medication, resulting in an estimated annual cost to the healthcare system of between $100 billion an $289 billion.

Of course, it can be easy to write this issue off as the patient’s responsibility, and naturally they have a huge role to play in solving this issue. There are, however, myriad factors that contribute to non-adherence of the 4.45 billion prescriptions written in the US each year.

The medication-taking experience is a complex interaction that involves patient, physician and the broader healthcare system, and all of these protagonists need to be functioning together correctly if we are to reach a state where avoidable medical treatment is minimized.

Given that increased adherence would not only greatly improve patient outcomes, but also save the healthcare sector billions of dollars, addressing this pervasive issue should be a priority for the industry. But what really causes it, and how can we improve our approach?

The patient
From the patient’s perspective, there are a number of factors that can contribute to the non-adherence of prescribed medication. One overarching theme for patients is patient activation and empowerment. The healthcare system isn’t constructed to ensure patients take on the role in self-management expected of them. Our paternalistic healthcare system can often make patients feel disempowered, and excluded from care decisions.

A poor understanding of both their condition and the medication that has been prescribed can lead to a lack of ownership of and accountability for the management of their condition. In numerous reports, patients are overly concerned about side effects, lack understanding on how to take the medicine safely, and may not understand why it is so important to continue to remain in therapy (especially in asymptomatic non-communicable diseases). Increasing the patient’s understanding of their condition, and the management thereof, can play a significant role in increasing adherence.

Sometimes, of course, non-adherence isn’t a deliberate decision by the patient, but an unintentional side effect due to capacity and resource limitations. For example, problems physically accessing prescriptions, a prohibitive cost, or competing demands on a patient’s time can all result in non-adherence.

Literacy is also a large contributing factor – in the US alone, close to 90 million adults have inadequate health literacy. The consequential lack of understanding puts them at greater risk of hospitalization and poorer clinical outcomes. Their beliefs about and attitudes toward health and treatment effectiveness, together with previous experiences with pharmacological treatments, also affect their level of adherence.
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