A Script for Change: Improving Medication Adherence

Sara Wettergreen, PharmD candidate 2014, South Dakota State University College of Pharmacy
Published Online: Monday, October 10, 2011
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Medication adherence has been a critical topic of discussion among health care professionals and the media in recent years.1 The World Health Organization defines medication adherence as “the extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care provider.”2

Taking medication as directed may seem simple, but nonadherence among individuals with chronic conditions is a complex and widespread public health problem. Nearly 3 out of 4 Americans report that they do not always take their medications as directed, which can lead to serious health consequences and significant costs. Many patients fail to fill their prescriptions or pick up their prescriptions from the pharmacy. Others pick up their medications but do not follow their health care professional’s instructions; for example, they might skip doses, stop taking a medication, take more than instructed, or take it at the wrong time of day.1

Medication nonadherence can influence treatment efficacy by preventing patients from receiving the full benefits of their prescribed medications. It can also cause complications and contribute to conditions that result in frequent emergency room visits and recurring hospitalizations.3 According to the New England Healthcare Institute, medication nonadherence costs the US healthy system an estimated $290 billion every year,4 a statistic that is compounded by the fact that chronic diseases affect nearly half of the US population. Of those patients, one third to one half do not take their medications as prescribed.4-5

Factors behind nonadherence
There are many reasons why patients people do not take their medications as directed. Some have trouble remembering, whereas others purposefully do not take their medication due to factors such as potential adverse effects related to the medication, belief that the medication is unnecessary, failure to get refills, or because the drug is ineffective for them. Other reasons contributing to non-adherence include unclear directions about proper administration, difficulty swallowing, difficulty opening containers, costs, and patient-initiated dose-adjustment or discontinuation.6 In addition, patients’ beliefs and perception about an illness and the medications used to manage it can interfere with a patient’s ability to cope with an illness and adhere to a regimen.7 Individuals often use personal beliefs, past experiences, and perceptions about conditions, medications, and the health system to guide the decisions they make at each stage of the disease management process. Research has shown that patients’ beliefs about their conditions and the medications used to treat them can affect the decision to take medication.8-9

Medication nonadherence is a complex behavior that varies across individuals and across medications. For example, the nonadherence rate among patients taking contraception is estimated at 8%, compared to 71% in those taking arthritis medications.10 The same patient might take one medication differently than the other. Health care providers need to recognize that medication adherence is individualized for each medication and for each patient. A patient’s behavior toward taking his or her medications as directed is characterized by that individual’s experience, beliefs in health, illness, and the type of medications being taken. Patients cognitively and emotionally assess the pros and cons of their therapy management, which then influences the decision whether to adhere to their medication regimen.7

Raising awareness
To address this important issue, student pharmacists from South Dakota State University (SDSU) are working to raise awareness among patients across the state about the importance of taking medication as prescribed. SDSU is one of dozens of pharmacy schools around the country participating in the 2011 Script Your Future Medication Adherence Challenge. Led by the National Consumers League, Script Your Future is a national coalition of more than 100 public and private stakeholder organizations that provides tools to help patients and health care professionals more effectively communicate about ways to improve medication adherence.

This month, students are developing and implementing activities such as presentations, informational booths, and blood pressure and blood glucose screenings to encourage patients and their caregivers to talk to their health care professionals about their medication regimens. Patients can also sign a pledge to take their medications properly.

Regardless of the reasons for nonadherence, too much of the time patients are not receiving the therapy that health care professionals have prescribed for them, which can lead to more serious health complications, reduced quality of life, and even early death. By focusing on 3 serious chronic conditions—diabetes, respiratory disease, and cardiovascular disease—Script Your Future aims to improve medication adherence, which in turn can contribute to lower health care costs and increased quality of life. SDSU has made it a priority to educate student pharmacists about the importance of communicating openly with patients about medication adherence, identify the challenges they face, and help develop solutions.

For more information, please visit Script Your Future’s Web site or Facebook page, or follow them on Twitter.



References
  1. Medication Adherence. Script Your Future Web site. www.ScriptYourFuture.org. Accessed September 22, 2011.
  2. World Health Organization. Adherence to long term therapies: Evidence for Action (Geneva, 2003).
  3. Raynor DK. Patient compliance: the pharmacist’s role. Int J Pharm Prac. 1992;1:126-135.
  4. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. New England Health Care Institute. www.nehi.net/publications/44/thinking_outside_the_pillbox_a_systemwide_approach_to_improving_patient_medication_adherence_for_chronic_disease. Accessed September 22, 2011.
  5. Chronic Diseases and Health Promotion. Centers for Disease Control and Prevention. www.cdc.gov/chronicdisease/overview/index.html. Accessed September 22, 2011.
  6. Vik SA, Maxwell CJ, and Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother. 2004;38:303-312.
  7. Horne R and Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002;17:17-32.
  8. Levanthal H, Brissette I, and Levanthal EA. The Self-regulation of Health and Illness Behavior 2003. (ed Routledge) 42-65.
  9. Mann,DM, Ponieman D, Leventhal H, and Halm EA. Predictors of adherence to diabetes medications: the role of disease and medication beliefs. Journal of Behavioural Medicine. 2009;32:278-284
  10. Annals of Pharmacotherapy (Editorial). Patient Compliance. Ann Pharmacother. 1993;27:S5-S24.


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