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 Medication Adherence - 2