Medication
adherence
Patient compliance
• "A faithful adherence by the patient to the prescribers
instructions".
• Thus, it is the patient's understanding and adherence to the
directions for use of prescribed drugs.
• Patient non-compliance means the patient is not following the
instructions for use of prescribed drugs.
Non-compliance
• Non-compliance with the prescribed therapeutic regimen
frequently produces adverse effects.
• Moreover, non-compliance results in either under utilization of
drugs or overutilization of drugs.
• The effects of underutilization include e.g. premature termination
of antibiotic therapy leading to bacterial resistance and recurrence
of infection.
• In antihypertensive therapy, thinking that blood pressure is not
well controlled, the physician may prescribe potent
antihypertensive and may lead to greater risk of adverse effects.
F
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1. Patient related Factors:
• (a) Patient Age, Sex, Education, etc.: Generally, younger
patients and elderly show poor adherence. Women tend to be
more adherent than men.
• (b) Education: Illiteracy as opposed to educated people show
poor adherence. Awareness regarding health, health
problems, importance of health all play important role in
matters of adherence.
• (c) Physical Disability: Poor eyesight, restricted physical
movements contribute to poor adherence.
• d) Cultural Attitudes: Ignorance about importance of modern
medicine, cultural misbeliefs, preference for traditional
remedies leads to poor adherence.
• (e) Economic Factors: Cost of medicines and affordability
influence the purchase of medicines.
• Medicines are taken less frequently than prescribed or
prematurely discontinued because of cost. This results into
non-adherence.
2. Disease related Factors:
• (a) Worse Prognosis: Disease states with a known worse
prognosis such as; cancer or rheumatoid arthritis elicit better
adherence rates.
• (b) Specific Disease States: Hypertensive patients are
asymptomatic Le. they do not experience symptoms prior to
initiating the therapy.
• Convincing them the importance of therapy is a difficult task
and when are not convinced tend to nonadherence the
therapy.
3. Doctor related Factors
• a) Too many Drugs Prescribed:
• Thoughtlessly prescribing too many drugs (multidrug therapy)
leads to a greater risk of non-adherence.
• Similarity in appearance (e.g. size, shape, colour) of prescribed
drugs may lead to confusion of the patient and thus to the non-
adherence.
• (b) Poor Interaction with Patient:
• The instructions regarding why, how and when to take
medicines should be given to patients using effective
communication skills.
• Effective interaction with patients largely results into
adherence.
• c) Failure in Inspiring Confidence:
• Doctor's overall attitude towards patient, failure in
establishing good rapport with patient and demonstrating
concern about patient all have powerful effect to encourage
confidence in patient.
4. Prescription related Factors
a) Illegible and Inaccurate Prescription: Illegible prescription
may lead to conclusion that doctors concern to patient is
questionable. Prescribing high dose leading to toxicity.
b) Failure to Refill Prescription: For different reasons, patients
avoid or neglect the refilling of prescription especially in
cases of chronic diseases.
c) Polypharmacy: Sometimes the prescription may be too
complex due to multiple drug therapy prescribed.
It has been shown that the greater the number of
medications, the poorer the adherence.
5. Pharmacist related Factors
• a) Professionalism: Pharmacist information and advice can be
valuable reinforcement. Patient counselling is a part of clinical
pharmacy practice that achieves the objective of providing
maximum therapeutic benefit to the patient.
• Pharmacist should inform, educate and counsel patients for
each medication in the patients drug regimen. This practice
of pharmacy ensures better adherence.
• (b) Patient Counselling: Patient counselling by the pharmacist,
before dispensing of prescription in the matters such as; safe
and appropriate use of medications, name and purpose of
medications, administration of drugs, timing of the dose,
duration of use, side effects and refill information have
profound effect on adherence by the patient.
6. Health System related Factors:
• a) Long Waiting Times: When a patient experiences a
significant waiting in getting to see his physician or having his
prescription filled, the annoyance may contribute to poor
adherence.
• b) Uncaring Staff: The healthcare system may be biggest
hinderance to adherence. Uncomfortable environment,
uncaring staff exhausted drug supplies have a major impact
on adherence.
• (c) Accessibility: In many of the situations, there is a problem
of distance and accessibility of the clinic from the patient.
• Studies have shown that patients furthest from the clinic are
least likely to adhere to the treatment in the long-term.
