7 causes of medication nonadherence

18 Sep, 2020

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?

1. Fear and worry

As a patient, it’s common to have anxiety around new medication. Perhaps you are scared of expected side effects or becoming too dependent on a medication. This may result in you intentionally not taking your medication and then fearing to tell the truth to your healthcare provider, which is why it is important to weigh the potential side effects of a medication against the gains of taking it. However, this is ultimately the job of your healthcare provider to evaluate. But there are many other kinds of fears and worries as well... For instance, as a child, you may fear stigma from peers over being sick and you avoid having to take medication in front of classmates as you think you could be bullied.

2. Cost

Unfortunately, the cost of medication can be out of our budget which can result in some of us not collecting our intended medication or trying to reduce our dosage and prolong our current supply for as long as possible to reduce the cost burden. This is sadly a common reality for many who wish they could be more adherent and live healthier lives, however the price of their medication hinders them. Your medication is meant to be taken as it was prescribed, not reduced in dosage to prolong supply.

"...you may become non-adherent despite the medication needing to be taken for three months in order for you to start seeing results."

3. Misunderstanding

The need for the medication, how long it takes to see results, and what the side effects of the medication are can be misunderstood or remembered differently after meeting with your healthcare provider. If you fail to see results after one month, you may become non-adherent despite the medication needing to be taken for three months in order for you to start seeing results. This can also lead to a lack of trust, as you may be doubtful of claims from your healthcare provider after seeing a medication advertised heavily, believing that the motives for being prescribed that medication are not right.

4. Adverse side effects

For many, the side effects of a new medication may be too negative or intense for you to wish to continue being adherent. Similar to fear and worry, you may intentionally stop taking their medication due to the side effects. For example, birth control pills may heighten your depression or cause more hormonal acne despite offering you an advantage in avoiding pregnancy – so you become non-adherent to keep a stabilized mood or clear skin.

5. Too many medications

When you have many medications to keep track of, your memory may miss some doses. Supporting your medication organization is important in addition to having set reminders to take doses throughout the day at the right time intervals. Setting alarms or scheduling slots into your calendar to medicate are always helpful. When you add in travel or a prescription that has run out, this makes it even harder for you to stay adherent. By being proactive, you will save yourself time and stress later on.

"Ensuring that patients such as children understand the impact of not taking their medication is critical."

6. Lack of symptoms

When you do not feel a difference taking your medication, you may stop medicating despite the fact that some symptoms cannot be seen or felt directly, especially if your condition is asymptomatic. Ensuring that patients such as children understand the impact of not taking their medication is critical. Lack of symptoms does not equate to being healthy.

7. Suffering mental health

If you suffer from an illness such as depression which negatively alters your mental state, this can impact your ability to take your medication because the task becomes much heavier to carry through. Mental health support along your journey is key to ensure that you can feel the best you can to actively contribute to their own treatment.

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 medication(s) 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 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.

Finally, tackling the issue of cost is a complex topic. Healthcare systems vary between countries and there is no one size fits all approach. However, as a society we have a collective need to ensure that people who need medication and treatment receive it. Poor medical adherence is an issue that contributes up to $300 billion in healthcare expenditure annually [1]. If patients are prolonging their doses or not picking up prescriptions because they cannot afford them, then this is a problem that needs to be addressed because cost should not hinder basic health. Furthermore, it exacerbates cost issues for society in the long-term once a patient’s health further declines.

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 ensure better lives during treatment.


[1] “Thinking outside the pillbox: A system-wide approach to improving patient medication adherence for chronic diseases”, New England Healthcare Institute (NEHI), July 2009

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