Prescription Non-Adherence: A Bitter Pill to Swallow

Patient non-adherence to prescription drug regimens has a number of causes. Here are a few, along with some possible solutions.

Did you take your medicine the right way for the prescribed time the last time your doctor wrote you a prescription? If you did, you are in the minority.

A review of drug adherence and strategies to overcome non-adherence highlights some of the issues:

1. "Adherence" has replaced "compliance" to reflect a more bilateral responsibility and be less paternalistic

2. Non-adherence is a big problem and contributes to adverse outcomes and added cost and waste

3. Prescription sharing is common. Many patients just throw away their drugs, contaminating the

environment

4. Patients usually don't take their medicine because 1) they don't accept that they have a serious medical problem; 2) they don't trust the person who prescribed the medicine; 3) they don't think the medicine will work or they have a bias against drug therapy and experiment with non-pharmacologic solutions. Also, as you have seen in the headlines, 10% of patients don't take their medicine because they simply can't afford it.

5. Strategies to address non-adherence typically fall into five categories: a) technological solutions—putting things into pills or on to pill bottles to track whether the patient took the drugs the way they were supposed to; b) behavior modification techniques using reminders or digital health solutions; c) packaging solutions making it easier for patients or those taking care of them to remember when they should take their medicines; d) dosing solutions, since the more doses you have to take, the less likely you are to take them all; and e) ways to make drugs more affordable.

6. The flip side of the non-adherence problem is the doctor: creating trust, communicating the importance of taking the medicine, and getting them point of care information so they can prescribe the right medicine at the right dose to the right patient at the right time. Even when doctors get evidence-based prescription guidelines, a large percentage don't follow them anyway.

7. Alternative dosing and delivery solutions, like patches, implants, and extended-release technologies represent big commercial opportunities

8. Payers are beginning to get into the game, using patient education strategies that they hope will lead to higher health IQs resulting in patient engagement, behavior modification and, eventually, smarter health choices that lower cost.

9. More and more older patients are taking more and more medicines. Many have surrogates, family or personal representatives and other caregivers who, in fact, are responsible for making sure Mom takes her medicine. The target for non-adherence strategies, therefore, is often not the patient but a caregiver instead-a fourth party intermediary.

10. Behavioral economists are suggesting ways to change patient behavior, using various carrot and stick techniques.

Not taking your medicine is a major sick-care and disease-prevention problem and therefore represents a big commercial opportunity. But, is still is a bitter pill to swallow.