From the Guidelines
Non-adherence with medical care is primarily caused by multifactorial barriers, including medication costs, complex regimens, side effects, lack of understanding, and psychological factors, as identified in the most recent study 1. To address non-adherence, healthcare providers should first identify the specific barriers preventing adherence. Implementing a multi-faceted approach is most effective, starting with simplifying treatment regimens when possible, such as using long-acting formulations or medications that can treat several conditions simultaneously 1.
Key Barriers to Adherence
- Medication costs
- Complex regimens
- Side effects
- Lack of understanding
- Psychological factors Clear communication is essential, and providers should use plain language to explain the purpose of treatments, expected benefits, potential side effects, and proper administration techniques 1.
Strategies to Improve Adherence
- Simplify treatment regimens
- Use clear communication
- Involve patients in decision-making
- Use medication organizers, smartphone reminders, and regular follow-up appointments
- Consider medication reconciliation to eliminate unnecessary prescriptions Non-adherence often stems from legitimate concerns about treatments, so creating a non-judgmental environment where patients can openly discuss their challenges is crucial for developing personalized solutions that improve long-term adherence and health outcomes 1. The most recent study 1 emphasizes the importance of assessing adherence as a routine part of care, as non-adherence increases with polypharmacy and is associated with adverse outcomes. By addressing these barriers and implementing effective strategies, healthcare providers can improve patient adherence and ultimately reduce morbidity, mortality, and improve quality of life.
From the Research
Causes of Non-Adherence
The causes of non-adherence with medical care are complex and multifaceted. According to 2, the most commonly reported barriers to medication adherence across conditions include:
- Younger age
- Low education
- Low income
- High medication cost
- Side effects
- Patient beliefs/perceptions
- Comorbidities
- Poor patient-provider communication
Patient-Related Factors
Patient-related factors also play a significant role in non-adherence. As noted in 3, the causes of nonadherence may be related to the patient, treatment, and/or health care provider. Additionally, 4 suggests that older patients may deliberately choose not to adhere to medication (intentional non-adherence) to avoid adverse effects.
Healthcare System-Related Factors
Healthcare system-related factors can also contribute to non-adherence. According to 5, the medical profession largely ignores medication nonadherence or sees it as a patient problem and not a physician or health system problem. Furthermore, reimbursement systems may not reward health systems that improve medication adherence and chronic disease control.
Treatment-Related Factors
Treatment-related factors, such as the complexity of the treatment regimen, can also impact adherence. As noted in 6, no single intervention strategy has been shown to be effective in improving adherence across all patients, conditions, and settings. However, multifaceted interventions that combine different approaches, such as patient education, optimization of treatment, and use of adherence aids, may be more effective.
Interventions to Improve Adherence
Several interventions have been identified as potentially effective in improving adherence, including:
- Digitally delivered interventions, such as medication and condition education, motivational interviewing, and reinforcement and motivational messages 2
- Tailored interventions, such as electronic pill boxes combined with Short Message Service reminders, and tailored Internet interventions 3
- Multifaceted interventions that combine different approaches, such as patient education, optimization of treatment, and use of adherence aids 6
- Comprehensive Geriatric Assessment, patient education, and optimization of treatment 6