Former U.S. Surgeon General C. Everett Koop was quoted as saying, “Medications do not work in patients who do not take them.”
Of course, the concept seems obvious, but it does draw attention to the fact that there is a huge gap between medication therapy prescribed by physicians and medication use by patients. It has been estimated that the total worldwide cost of medication non-adherence, including direct and indirect costs, is in the range of $100 billion to $300 billion.
Physicians have struggled for a long time with how to encourage patients to take their medications more regularly. In the past, those who did not do so were often labelled as non-compliant. Yet contemporary medicine recognizes that there are many legitimate reasons why patients choose not to take prescribed medication. It is also understood that the physician-patient relationship benefits from partnership and open communication in an effort to build a therapeutic alliance.
During the last 50 years, there has been a worldwide shift in the burden of disease from acute infectious illness to chronic disease. During the same interval, many new and effective therapies have been developed to manage chronic disease, reduce complications and improve patient outcomes.
A patient today with diabetes mellitus, cardiovascular disease or chronic kidney disease (just to name a few) has access to a wealth of treatment options that would not have been available to their grandparents or even parents. To be sure, this evolution of medical treatment has fueled improvements in health-related quality of life and an ever-increasing lifespan in the developed world. Yet the full benefit has not been realized at least in part because of the challenge of medication non-adherence.
Adherence has been defined as taking more than 80 percent of prescribed medication. Studies have shown that, on average, patients take less than half of their prescribed medication. Persistence with medication use, particularly for chronic conditions, is another problem. For common conditions such as hypertension, there is evidence that many patients discontinue medication within 90 days of their prescription.
The World Health Organization has said that increasing medication adherence may have a far greater impact on the health of the population than any improvement in specific medical therapy.
The reasons why people choose not to take their prescribed medications are many. Cost may limit access. Adverse side effects or medication interactions may also have an impact. The use of medications may be affected by health or cultural beliefs, health literacy, mental illness or impairment, or even visual impairment.
Medical providers and health systems also contribute to medication non-adherence among the patients that they serve. This may result from prescribing inappropriate medications or excessive amounts of medication. Many patients are unable to list which medications they take and even fewer can relate the purpose of the medication.
Other factors can include provider workload, which may affect time spent reviewing medication use including side effects and other patient concerns.
Medical providers are seeking ways to improve communication with patients and build an alliance with patients for the benefit of their health. The benefits of success are measurable. Not only do patients benefit from their medications when taken regularly, but the simple act of adhering to a treatment plan has been shown to improve health outcomes.
Dr. Matthew A. Clark is a board-certified physician practicing at the Ute Mountain Ute Health Center in Towaoc.