All of us have forgotten to take a pill. We are human and make mistakes. Some of us neglect to take our medication for accidental reasons, while for others it may be intentional. So, what are the main causes of medication non-adherence? By better understanding the causes, we can work to provide solutions for our patients that better support them along their journeys. The causes of nonadherence can be managed to reduce the risk of the patient not taking their medication. Let’s dive deeper into the causes to explore what continues to drive medication non-adherence.
1. Forgetfulness
Just like implementing any new habit, incorporating the act of taking medication into your daily routine can be a challenge at the start. It requires reminders, accountability, and drive to stay consistent. Even for veteran medicators, a change in environment or schedule can throw off their routine and lead to missed doses. It’s human nature to forget things, even when things have become routine. Perhaps a new medication even alters your memory capabilities, which is why reminders are vital along our medication journeys – to support us when we most need it.
2. Fear and Worry
As a patient, it’s common to have anxiety around new medication, perhaps around expected side effects or the social stigma of taking medication in public. This may result in a patient intentionally not taking their medication and then fearing to tell the truth to their healthcare provider. By educating the patient on their condition, their upcoming journey, how to cope with side effects, and the importance of their medication – they can be better supported to overcome any fears or challenges they may face. Medicine myths can be rejected and the patient can make more educated decisions, empowering them to have more constructive consultations with their doctor addressing their concerns. The right knowledge at the right time is extremely important.
3. Misunderstanding
What a medicine is prescribed for, how the medication should be taken (e.g. together with a meal or not), and for how long the medication should be taken is information that can often be misunderstood or misinterpreted between doctor and patient. It has actually been shown that only 49% of all patients remember the instructions given after a visit (see here) not to mention what this number is after a few weeks. This is one of the most common causes of poor adherence, and unsureness of how to take a medication might result in the patient not taking it at all, medicating in the wrong way, or even medicating in excess which could result in avoidable side effects. Ensuring that the patient has easy and accessible information to revisit when needed is an easy way to reduce this cause. Many of today’s smart solutions also offer feedback systems that present information that might be of interest for that individual based on behaviour patterns. When a patient fails to see results after some time, they may become non-adherent despite the medication needing to be taken for longer in order for you to start seeing true results. It is important to continuously educate the patient on their condition and medication to continue to build trust and support them when needed.
4. Adverse side effects
For many, the side effects of a new medication may be too negative or intense to wish to continue being adherent. Similar to fear and worry, a patient may intentionally stop taking their medication due to the side effects. It is important to report any adverse side effects and to discuss with a doctor how to manage side effects that will appear along the way and when it is time to change medication if they become too negative. Ensuring that adverse events can be easily and quickly reported, while also continuing to educate patients of the natural course of side effects and potential, serious side effects is crucial.
5. Complex medication schedules
Complex medication schedules require supporting your medication organization in addition to having set reminders to take doses throughout the day at the right time intervals. For some patients, such as minors, others may have to be involved to support the patient in medicating. Accountability helps a patient stay on track, so incorporating support from a partner or caretaker is beneficial. Adding in reminders that a prescription has run out can also further support patients to stay proactive and support their adherence.
6. Lack of symptoms
It has been shown that it is particularly difficult to maintain a medication taking behaviour when the medicine is of preventive nature. If a medication is taken to avoid an event in the future and when the patient does not feel any direct positive effect from taking the medication or direct negative effect from not taking the medication it is of course even harder to keep the motivation high. Imagine the difference in short term motivation in taking painkillers when having a headache versus cardioprotective treatment that might prevent a heart attack in 15 years. The course of such non-adherence usually starts with missing one pill… and without any negative feedback then a few more doses are missed leading to maybe a whole week without medication – thus the behavior of taking medicine is broken and medicine taking stops. Lack of side-effects or taking medication in a preventive nature does not equate to being healthy. Again, this further illustrates the point of why continuously educating patients is beneficial.
7. Suffering mental health
If a patient suffers from a mental illness which negatively alters their mental state, this can impact a patient’s ability to take their medication on schedule and as prescribed. Mental health support along a patient’s journey is key to ensure that they can feel the best they can to actively contribute to their own treatment. Therefore, empowering a patient with the knowledge of when to seek help, if they need it, can be crucial
How can we tackle these causes?
Medication adherence has always been a problem, but today we are fortunate to have cutting edge technological solutions to curb an increase in medical nonadherence paired with healthcare systems that are dedicated to improving their quality of care and treatment.
First and most easily, we can support medication organization and reminders easily by using apps on our phones and a simple pill organizer. Different people prefer different organization styles, but an old school pillbox and setting reminders always helps.
Secondly, we can work to facilitate better relationships between healthcare providers (HCPs) and patients so that they feel there are open communication channels and that they can express their concerns and what hesitations might keep them from taking their medication as prescribed. This also ties into helping to clear up misunderstandings, which can be further supported by clear information and instructions for patients regarding their medications that are always accessible. Supporting mental health also plays a role here, as we can check in on patients who are struggling in order to help them and ensure they stay adherent through tough times.
Third, when it comes to symptoms and side effects, this is where information and clear communication channels between the doctor and patient is again crucial. Patients need to be well versed in what they should expect during their medication journey, and how they can best deal with negative side effects and how to evaluate if they are too risky for taking the intended medication. There should be trust between the two parties, but especially towards the doctor as they have the patient’s wellbeing in mind. If a patient can easily record their side effects, this allows them to report back to their doctor if they are facing issues that need to be addressed. Empowering them with knowledge allows them to have more constructive and beneficial conversations with their healthcare provider.
Fourth, incorporating psychology into how technological solutions are shaped to tackle medication adherence can help to keep users motivated using elements of empowerment, continuous support, and gamification. This includes using positive language and reinforcement, displaying their performance in a gamified way to encourage them to stay on track, and possibly even reaching out to them when they need extra support as identified by trigger actions and behaviors in-app.
There is a need for an actor, utilizing technology, to bring together the stakeholders of this important problem. At Pilloxa we hope to be that actor and provide better solutions to patients who need it. Patients like you. Patients like all of us. Until then, an open conversation with your doctor about adherence concerns can often lead to more effective solutions and improved safety, confidence, and well-being. By being aware of the top causes of medical non-adherence, we can holistically work towards solving this issue and ensuring better lives during treatment for our patients.