Fast Facts: Medication Adherence: A practical approach to optimizing medication use

By P. Aslani, H.N. Young and M. Koo

Helping your patients to use their medications safely and appropriately is a critical aspect of clinical practice, but it can be challenging. The published literature on the topic of adherence is vast, and constantly growing and evolving. It is not feasible, nor necessarily helpful, to comprehensively summarize all the available evidence. Instead, this book aims to provide all health professionals with a succinct and handy resource on medication adherence. Importantly, the book focuses on practical information that can inform, and be applied in, day-to-day clinical practice. Table of Contents: • Terminology and definitions • Epidemiology • Identifying non-adherence • Interventions to support adherence

• Language: English
• Publisher: S. Karger
• Release date: Nov 3, 2021
• ISBN: 9783318069938

Book preview

Introduction

Hippocrates, widely considered as the ‘Father of Medicine’, told physicians to ‘keep a watch… on the faults of the patients, which often make them lie about the taking of things prescribed. For through not taking disagreeable drinks, purgative or other, they sometimes die.’¹ While we have made great advances in medicine and in our understanding of the health professional–patient relationship, it seems that medication adherence, or lack thereof, is an issue that transcends time.

At the start of the 21st century, the World Health Organization (WHO) described the issue of non-adherence to treatment by patients with chronic conditions as ‘a worldwide problem of striking magnitude’.² In 2017, a New York Times article stated that ‘there is an out-of-control [medication-related] epidemic in the United States that costs more and affects more people than any disease Americans currently worry about. It’s called non-adherence to prescribed medications…’³

‘Poor adherence to treatment of chronic diseases is a worldwide problem of striking magnitude.’

World Health Organization²

In developed countries, adherence among patients with chronic conditions averages only 50%.²,⁴–⁶ In less-developed nations, this is expected to be even lower given the paucity of health resources and the inequities in access to healthcare.²,⁷

Poor adherence can result in major clinical and economic consequences.² The clinical consequences depend on the condition, the efficacy and pharmacological properties of the medication and the extent of non-adherence.⁷ Fundamentally, as stated by former Surgeon General of the USA C. Everett Koop: ‘Drugs don’t work in patients who don’t take them.’ Good adherence is intrinsically linked to the effectiveness of a medication, so much so that the WHO has echoed the statement by Haynes et al. that ‘increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.²,⁵

‘Drugs don’t work in patients who don’t take them.’

C. Everett Koop, former Surgeon General of the USA

The economic consequences associated with poor adherence stem from the direct costs of not using a medication properly, including wasted medications, side effects and unintended consequences necessitating further treatment, and additional or substitute medications and healthcare utilization. Indirect costs include increased disability or absenteeism and reduced productivity.⁷–⁹ Globally, non-adherence is estimated to cost $USD269 billion annually – approximately 4.6% of the world’s total health expenditure.¹⁰

So, is there a solution to this issue? What is defined as good adherence in the first place? What contributes to non-adherence? What is the role of the health professional? Do interventions to improve adherence actually work? This book answers these questions and more.

Helping your patients to use their medications safely and appropriately is a critical aspect of clinical practice, but it can be challenging. The published literature on the topic of adherence is vast, and constantly growing and evolving. It is not feasible, nor necessarily helpful, to comprehensively summarize all the available evidence. Instead, this book aims to provide all health professionals with a succinct and handy resource on medication adherence. Importantly, the book focuses on practical information that can inform, and be applied in, day-to-day clinical practice.

References

1.Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304–14.

2.WHO. Adherence to Long-Term Therapies: Evidence for Action. World Health Organization, 2003. https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf, last accessed 7 June 2021.

3.Brody JE. The cost of not taking your medicine. The New York Times 2017;17 April. www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html, last accessed 7 June 2021.

4.Sackett DL, Haynes RB, Gibson ES et al. Patient compliance with antihypertensive regimens. Patient Couns Health Educ 1978;1:18–21.

5.Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev 2002;2:CD000011.

6.Nieuwlaat R, Wilczynski N, Navarro T et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014;11:CD000011.

7.FIP. Use of Medicines by the Elderly. The Role of Pharmacy in Promoting Adherence. International Pharmaceutical Federation, 2018. www.fip.org/file/1342, last accessed 7 June 2021.

8.Cutler RL, Fernandez-Llimos F, Frommer