Why is this a problem? Medication non-adherence can be defined as either the intentional or unwitting failure to take medications as prescribed. By not following the prescriber's orders correctly, the patient will experience decreased effectiveness of treatment which can lead to the worsening of their condition.

The resulting decline in health may lead to more emergency room visits and hospitalizations. These dangers are magnified in the elderly population who tend to have a longer list of medications. Not only does prescription medication non-adherence threaten patient health, according to the National Community Pharmacists Association (NCPA), it contributes approximately 290 billion dollars every year in added costs to the health care system in the United States.

Every year, the NCPA conducts a national survey targeting nine issues in non-adherence: These behaviors include whether or not, in the past 12 months the patient:

  1. Failed to fill a prescription
  2. Failed to refill a prescription
  3. Missed a dose
  4. Took a lower dose than prescribed
  5. Took a higher dose than prescribed
  6. Stopped a prescription early
  7. Took an old medication for a new problem without consulting a doctor
  8. Took someone else's medicine
  9. Forgot whether they'd taken a medication

The NCPA analyzes this data to come up with a report card for medication adherence. The score can range from 0 (non-adherence on all 9 factors) to 100 (perfect adherence). The most current literature outlines the year 2013 where the average score was a C+ (79). This score is surprisingly low and has inspired a movement towards increasing medication adherence rates.

What contributes to medication adherence problems?

“Patients' personal connection with a pharmacist or pharmacy staff is the top predictor of medication adherence.” - NCPA_

The NCPA used regression modeling to identify six main factors that contribute to medication non adherence. They are as follows, with the most important being at the top:

  1. Patients' personal connection with a pharmacist or pharmacy staff
  2. How easy it is for them to afford their medications
  3. The level of continuity they have in their health care
  4. How important patients feel it is to take their medication exactly as prescribed
  5. How well informed they feel about their health
  6. The extent to which their medication causes unpleasant side effects

The NCPA also identified different adherence trends among age groups. They found that older respondents were more likely to have non-adherence problems.

What are some solutions?

Medication non-adherence is a tricky problem because it is not always easily identified. Sometimes the problem lies within the healthcare system. Other times, non-adherence may be due to socioeconomic or drug therapy related factors. Once one can identify the source of the problem, he or she can tailor a solution to fit the patient's needs. The root of these solutions lies in patient education and counseling.It is essential for healthcare providers to create a trusting, comfortable relationship with their patients. Communication is key to solving medication adherence problems. An important thing to keep in mind is that many instances of medication non-adherence go unreported due to patients who feel threatened by direct questioning and might be unwilling to admit errors. Furthermore, prescription refill records and pill counts may not provide an accurate estimate of adherence rates. It is vital for healthcare providers, especially pharmacists, to keep a close eye on their patients' medication habits. A couple of years ago, the NCPA started an initiative: Pharmacists Advancing Medication Adherence (PAMA) to aid providers in an effort to improve the national report card. By raising adherence rates, everybody wins - patient health improves, health care costs go down, and pharmacies can increase their bottom line.