What patient-reported data can tell us about how to improve medication adherence
Patients share why they do (and don’t) take medications exactly as prescribed
When patients don’t take their prescriptions when and how they should, it may result in sub-optimal effectiveness, recurrent infection (in the case of anti-infectives), extended treatment duration, additional costs – and at its worst – harm. Some estimates associate medication non-adherence in the United States with 125,000 deaths, 10% of hospitalizations and $100 billion in costs annually.1
These and related stats leave healthcare providers struggling with the question: how can I help my patients take their medications as prescribed? To answer that question, we must first understand why patients don’t follow the prescribed treatment regimen.
Powered by the IBM Watson health PULSE® Healthcare Survey, a health poll asked 3,000 Americans in February 2020 about their opinions on taking prescription medications. Fifty-five percent of the respondents said they had received a prescription within the last 90 days.
Clinicians may find clues among these findings that can guide their efforts to help patients take their medications. For example:
- 98% of those who picked up or filled their prescription said they took the medication as prescribed.
First, we must acknowledge that this is self-reported data, making it more difficult to know if those who responded affirmatively really did take their medication exactly as prescribed. Consumers may believe they have adhered to prescription instructions, but they might not be aware of their own missteps.
Second, we will have to consider how these responses might be different if this poll had been taken today – during the COVID-19 pandemic – rather than in February. For example, an April 2020 IBM Watson Health PULSE® Healthcare Survey found that 48% of U.S. healthcare consumers said they have delayed routine healthcare appointments and 31% have delayed a necessary healthcare service. Delaying services could potentially cause disruption to medication adherence, too.
Interestingly, the poll also found the rate of medication adherence tends to increase with age and decrease with educational attainment. The correlation with age surprised me, as you would expect that non-adherence in the elderly would be greater due to their longer lists of maintenance medications and increasing complexity in medication regimens. Understanding why more educated people are less likely to take medications as prescribed will require more exploration. One hypothesis is that these patients may feel more empowered than others to make decisions about managing their care.
- 29% of respondents who did not pick up their prescriptions2 said it was because they felt better or didn’t need it.
This response could represent a gap in understanding. Health literacy is associated with improved medication adherence.3 Perhaps clinicians could do more to inform patients as to why the medication has been prescribed, and why and how it should be taken. Consumer education might help close this gap and help persuade patients as to the importance of their conditions and medications to their overall health and wellness.
- 18% of respondents who did not pick up their prescriptions4 cited cost as the reason.
I anticipate that many healthcare providers might have expected cost to be a more significant factor in patients’ decisions to not pick up prescriptions. I was surprised to see the percentage attributed to cost so low and leads me to question if we are focusing enough on understanding other factors that lead to non-adherence. In addition, we may have seen a different response if this survey were taken now, when there are higher rates of unemployment and economic concern due to the pandemic. Inequities are an increasing concern for clinicians as COVID-19 disproportionately affects vulnerable populations.
Improving medication adherence won’t be a one-size-fits-all solution
As a former practicing clinical pharmacist, I can draw from personal experience to add other potential reasons for non-compliance to this list. For example, one patient may be experiencing a side effect from their medication that is less tolerable than the original condition. Another patient may not understand their regimen because it is too complex. Still another patient may be suffering from depression and need help managing that condition before a healthcare provider can address medication adherence.
Medication adherence is certainly an area that requires further study and conversation. What works for one patient may not work for the next. The more clues healthcare providers can collect about patient motivation and behavior, the more prepared they can be to meet their patients where they are and deliver what healthcare consumers need most: improved overall health and wellness.
- Kini V, Ho PM. Interventions to Improve Medication Adherence: A Review. JAMA. 2018 Dec 18;320(23):2461-2473. doi: 10.1001/jama.2018.19271. https://www.ncbi.nlm.nih.gov/pubmed/30561486
- https://www.ibm.com/downloads/cas/ZZKQV86Y Note: Care should be taken in interpreting these results due to the small sample size that responded to this question.