Studies have shown that at least half of individuals on chronic treatment do not take their medications as prescribed, so they do not fully benefit from treatment. This increases their chances of developing complications, resulting in more hospital visits and sometimes even death.
What is medication adherence?
The World Health Organization (WHO) defines medication adherence as the degree to which a person’s behavior corresponds with the agreed recommendations from a healthcare provider.
The term compliance is sometimes used to describe adherence. WHO stresses the need to differentiate between the two. Compliance is a passive behavior where the individual simply follows instructions from a provider. They simply do as they are told.
Adherence on the other hand is an active choice, an individual follows through with treatment while taking responsibility for their health. This often results in positive lifestyle changes.
There are several factors that contribute to non-adherence ,these can be linked to the three known types of non-adherence.
Types of non-adherence
Primary non-adherence also referred to as non-fulfilment adherence, refers to a situation where prescribed medications are never collected or used. An individual visits a provider and is prescribed medication, but fail to take the prescription to a pharmacy to have it filled. In some cases ,medications may be collected from a pharmacy but never used.
Non- persistence adherence on the other hand describes a scenario where an individual starts treatment and then stops without consulting with their healthcare provider. This could either be intentional or unintentional.
There are several factors that contribute to unintentional non-adherence. These include breakdown in communication between the patient and the provider, patient is unsure as to how long they are meant to take treatment. Cost is another factor, prescribed medications may simply be unaffordable for the patient . Intentional non- adherence on the other hand has a lot to do with an individuals beliefs, attitude, and expectations.
Non-conforming adherence is the most common type of non adherence seen in clinical practice. Here the individual continues taking treatment but do not follow the prescribed schedule or dosage. Individuals often skip doses, do not take treatment on time, and at times do not take the correct dose.
Dangers of non-adherence
Non-adherence prevents individuals from fully benefiting from treatment. It increases risk of developing complications. For individuals living with diabetes this means increased risk for amputations, blindness, and kidney failure.
Non-adherence affects quality of life and may result in loss of independence due to complications. It is costly for both the individual as well as the healthcare system.
| Common reasons for nonadherence. |
|---|
| Patient belief and understanding about health condition and treatment. 1. Patient does not fully understand the diagnoses or the benefits of treatment. 2. Patient has a fear of side effects. |
| Complicated treatment regimens 1. Polypharmacy : Patient taking 5 or more medicines a day. 2. Complicated dosing schedule. |
| Adverse Events 1. Unwanted weight gain 2. Hypoglycemia (low sugar) common for those on insulin 3 .GI side effects e.g. diarrhea, bloatedness |
| Individual challenges 1. Treatment impacts on an individuals social life. 2. Difficulty with using a device e.g. inhaler. 3. Pain at injection site (insulin) 4. Trypanophobia (fear of needles) 5. Affordability |
Tips to improve Adherence
- Pack your medication in a pill box
- Set daily reminders on your phone.
- Use a medication tracking sheet to help keep track of your medication adherence
- Pair taking your medication with a daily routine like brushing your teeth or eating breakfast
The World Health Organisation , emphasizing the importance of adherence stated that, improving adherence interventions could have a greater impact on public health than advances in medical treatment.
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