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however , is not necessarily aware or informed of this , and this can lead to misinformation or disinformation that might affect the willingness of the person to take the medicine at all ( non-adherent ) or take it as directed ( partially non-adherent ). A patient can be termed ‘ non-adherent ’ in two ways : namely , intentionally , or unintentionally . Arguably it is easier to mitigate against the unintentionally non-adherent patient as generally we know that this person has accepted the necessity of the medication over the risks that this might pose , and could for another reason , for example , poor memory , not be able to reliably take this medicine as directed .
Strategies to help with this tend to be quite straightforward and examples include memory aids , blister packing and text reminders to help patients manage their medicines .
However , the situation might be less straightforward : think of the patient who has suffered a stroke , for example . After the stroke , the patient might experience aphasia or dysphagia and therefore will require the expertise of a hospital pharmacist to undertake a medicines reconciliation . In this medication reconciliation , the pharmacist will have to assess each drug individually and determine its appropriateness to be crushed / chewed / mixed with food / fluids , in line with best practice . 5 In other words , they are optimising the medication for this patient by tailoring the drug regimen to align with the patient ’ s unique requirements .
There can also be an impediment ability of the patient to access the medicines ; for example , an adult with rheumatoid arthritis who might have difficulty opening the medicine container . Again , here there is an opportunity for a hospital pharmacist to discuss medicine challenges with the patient prior to discharge and liaise with colleagues in the community to put the medicines in easy open containers .
By far the more complex and , as a researcher I would say , the more interesting phenomenon is the patient who has ‘ decided ’ to be intentionally non-adherent . The decision might not be a conscious one , but rather due to the number of different variables that are involved in the decision-making process . It might be sub-conscious : either way , the effect is the same – the patient will not take the medication as prescribed .
Factors affecting medication-taking behaviour What are the factors that can negatively or positively impact upon medication-taking behaviour ? When referring to behaviour , we must consider the capability , opportunity and motivation that ultimately leads to the behaviour . This is known as the COM-B model . 6
Capability There are many facets to capability , some above include the physical capability , psychological capability , but others may not be quite so obvious , there is the financial capability . Can the patient afford these medicines , particularly if they are for a chronic disease / disorder and especially if the disease is not interfering with their daily life ? An example here would be type 2 diabetes mellitus . Having elevated blood glucose levels and how this will relate to cardiovascular health in five years can be an abstract concept and is in direct contrast to someone who is experiencing pain and needs pain relief immediately . Evidence shows that where the course of treatment is shorter the adherence is likely to be higher and vice versa . In 2003 , it was estimated that only half of those who suffer with chronic conditions take their medications as prescribed , making medication adherence improvement a priority of the public health agenda . 7 A 2019 study conducted on adherence to medicines for those with chronic conditions had similar findings and concluded that the proportion of adherent patients to treatment was 55.5 %. Older age ( adjusted OR1.31 per 10-year increment , 95 % CI 1.01 – 1.70 ), lower number of pharmacies used for medication refills ( 0.65 , 95 % CI 0.47 – 0.90 ), having received complete treatment
It is thought that non-adherence contributes to the premature deaths of 200,000 Europeans per year
information ( 3.89 , 95 % CI 2.09 – 7.21 ), having adequate knowledge about medication regimen ( 4.17 , 95 % CI 2.23 – 7.80 ), and self-perception of a good quality of life ( 2.17 , 95 % CI 1.18 – 4.02 ) were independent factors associated with adherence . 8
In addition , the perception of the need for this medicine must be higher that the perceived inconvenience / financial burden that this imposes . Although there are differences in how people pay for their medicines throughout Europe , and the mechanisms by which they could avail of reduced cost / free medicines , this also requires a capability on the part of the patient . To help with this , a hospital pharmacist might be able to liaise with their community pharmacy colleagues to enable the correct paperwork to be submitted / completed for the patient so that there is a seamless transition from one care setting to the next .
Health literacy Health literacy has recently been redefined to take account of the personal health literacy , that is , the degree to which individuals have the ability to find , understand , and use information and services to inform health-related decisions and actions for themselves and others ; and organisational health literacy , that is , the degree to which organisations equitably enable individuals to find , understand , and use information and services to inform health-related decisions and actions for themselves and others . 9 Again there is a potential role for the pharmacist to engage with the
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