Medication Adherence: Consequences of Non-Adherence | Part 1

When patients don’t take their medications as prescribed, this is unfortunately fairly common. The non-adherence may have added consequences for patients with chronic diseases that need to be well controlled in order to prevent deterioration of their underlying condition. Not all non-adherence is the fault of the patient.

Reasons for Non-Adherence may be classified as intentional or unintentional. Some of the reasons for non-adherence are as follows:

Fear

Patients may be afraid of potential side effects. They may have also experienced previous side effects with the same or similar medicine. Additionally, patients report not taking their medication because they may have witnessed side effects experienced by a friend or family member who was taking the same or similar medication. Seeing those side effects experienced by someone else may have led them to believe the medication caused those problems.

Cost

A major barrier to adherence is often the cost of the medicine. The high cost may lead to patients not filling their medication scripts.  They may even ration what they do fill in order to extend their supply such as halving doses or skipping doses.

Misunderstanding

Non-adherence can also happen when a patient does not understand the need for the medicine, the nature of side effects or the time it takes to see results.

Too many medications

When a patient has several different medicines prescribed with a higher frequency of usage, the chances that they are non-adherent increase. Not only do the side effects increase but trying to remember when and how to take different medications that all come with their own set of instructions becomes difficult.

Lack of symptoms

Patients who don’t feel any different when they start or stop their medicine might see no reason to take it. Additionally, once a patient’s condition is controlled, they may think the problem has been resolved and may discontinue using the medication.

Mistrust

There has been news coverage of marketing efforts by pharmaceutical companies influencing doctors’ prescribing patterns. This ongoing mistrust can cause patients to be suspicious of their doctor’s motives for prescribing certain medications.

Worry

If a patient is concerned about becoming dependent on a medicine, it can also lead to non-adherence.

Depression

Patients who are depressed are less likely to take their medications as prescribed. Mental health problems put patients in a state of hopelessness, hence they don’t have the motivation to get better or just cannot remember to take medication because the emotions are so overwhelming.

Old Age or Busy Schedule

Many patients throughout their busy schedules tend to forget to take medication. In the case of older patients, they tend to forget very easily or have underlying dementia that may affect memory. With the elderly there may be disabilities such as loss of sight and hearing as well as loss of the ability to use their joints. In these circumstances the lack of support or caregiver to assist the elderly may result in non-adherence. This is not intentional non-adherence.

Lack of access to a pharmacy or medical care

If patients are living in remote areas, stock quantities and availability of certain medications may not be available, or patients do not have access to reliable transportation. Again, this is not intentional on the side of the patient.

Requirements for Cold chain

Certain medications require the use of a cold chain or certain storage conditions under temperature control. If patients do not have access to a refrigerator or have frequent power outages and are unable to maintain the cold chain, this leads to rather inefficacy of the medication which then may get interpreted as non-adherence, however, is not the fault of the patient.

Look out for our next article which further unpacks Consequences of not taking medication as prescribed.