Mount Carmel Health Partners Clinical Guidelines Medication Adherence | Page 2
Not taking medication as prescribed—taking either too little, or too much, for too short, or too long a period,
at the wrong time or in an ineffective way—can have negative consequences for patients, healthcare, and
the economy.
World Health Organization
Compliance vs. Medication Adherence
Factors of Non-Adherence
• Compliance is the extent to which a patient’s behavior
matches the prescriber’s advice.
• Poor communication
• Compliance implies patient obedience to the physician’s
authority.
• Lack of understanding of need for treatment
• Adherence signifies that the patient and physician
collaborate to improve the patient’s health by integrating
the physician’s medical opinion and the patient’s lifestyle,
values and preferences for care
• Complex regimes
• Inadequate knowledge about drug and its use
• Fear of side effects
• Frequent changes in regimen
• Treatment that requires mastery of techniques
• Cost
• Lack of health insurance
• Access
Types of Non-Adherence
• Lack of symptoms of disease, e.g., hypertension
• Patient forgets to take medication
• Non-fulfillment—prescription is never filled.
• Non-persistence—patients decide to stop taking a
medication after starting it, without being advised by a
health professional to do so.
• Non-conforming—includes a variety of ways in which
medication are not taken as prescribed; this behavior can
range from skipping doses, to taking medications at
incorrect times or at incorrect doses, to even taking more
than prescribed.
• Literacy level
• Duration of therapy
• Medications with social stigma
• Lack of immediate benefit of therapy
• Lack of family or social support
• Unstable living conditions
• Missed appointments
• Limited English proficiency
• Lack of continuity of care
• Restrictive formularies
Consequences of Non-Adherence
• Treatment interferes with lifestyle
• Waste of medication
• Motivation
• Disease progression
• Fear of dependence
• Reduced functional abilities
• Alcohol or substance abuse
• Lower quality of life
• Provider-patient relationship
• Increased utilization of nursing homes, hospital emergency
room visits and admissions
• Depression
• Psychosocial stress, anxiety
• Increased mortality
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