Medication adherence — taking drugs exactly as directed by a doctor — is a critical factor in health outcomes and the treatment of chronic disease. However, many patients fail to follow through with their doctors’ instructions, which can lead to worsening health and unnecessary hospitalizations. In turn, these patients face increased health care costs, and the entire health care system experiences avoidable strain.
This issue is a complicated one with multiple underlying causes. By exploring the reasons behind a lack of follow-through with medications, pharmacists and health care providers can work to bridge the gap between patients and the prescription drugs that they need.
Why Patients Have a Lack of Follow-Through With Their Medications
For many patients, a lack of follow-through with medications can be linked to one or more of the following issues.
1. High Medication Costs
The U.S. Census Bureau reports that 30% of American adults have skipped medications because of cost. If a patient cannot afford a medication for their chronic illness, they may have to ration pills or quit taking the medicine altogether. This lack of follow-through can lead to fluctuations in their health or keep the drug below therapeutic levels.
Healthcare providers cannot fault cash-strapped patients for this sort of scarcity decision-making. When patients are forced to choose between essentials like paying rent and buying groceries, it’s understandable that many of them will cut corners with their treatment regimen.
2. Lack of Insurance or Insufficient Coverage
Around 8% of Americans don’t have health insurance, according to the Census Bureau. Patients without insurance struggle to cover the costs of medical treatment and prescription drugs. Even with insurance, gaps in coverage or high deductibles can leave some patients unable to afford treatment.
Uncertainty about cost or coverage options may drive poor adherence as well. Some patients may decline to go to a pharmacy or inquire about a prescription because they assume that it won’t be covered or that it will be too expensive.
Physician communication plays a key role in addressing this issue. Providers who adopt in-office dispensing programs and openly communicate with their patients about the cost of prescriptions can help ease financial concerns. Physicians can also work with pharmaceutical companies and insurance providers to identify covered patient medications to reduce out-of-pocket costs.
3. Confusion About Dosage or Usage
Many patients, especially those managing multiple health conditions, have complicated medication regimens. When they have to juggle too much information about dosages, they can easily get confused and disorganized. They may miss doses, take them at the wrong time, or otherwise use their medications incorrectly.
A lack of health literacy is a major driver of patient adherence issues. When providers and pharmacists educate patients about their medications and how to take them, they should emphasize the importance of medication adherence. They should also make this information readily available for patients to reference from home.
When physicians are working with older patients or those who are prone to confusion, educating family members or caregivers about the medication regimen can help promote better adherence.
4. Poor Communication Between Patients and Providers
A breakdown in communication between healthcare providers and patients is another significant factor in nonadherence. Patients should trust their providers and understand why specific interventions are being recommended.
Likewise, physicians and care providers need to make their patients feel heard and respected. Involving patients in their care journey can help them take ownership of the decision-making process.
Additionally, providers should be honest and realistic about the repercussions of noncompliance. This means discussing the potential for worsening health conditions or declining patient health. When patients know what’s at stake, they may be more likely to follow up with recommended interventions, including medication.
5. Asymptomatic Conditions
Some chronic conditions, such as hypertension or high cholesterol, do not have easily identifiable symptoms. This can cause patients to falsely believe that they do not need their blood pressure medications or statins.
Providers can promote adherence by clearly outlining the progressive nature of asymptomatic conditions like high blood pressure or high cholesterol, explaining the purpose of medications and the importance of early intervention. They should emphasize the severe long-term consequences of untreated conditions, including organ damage or an increased risk of strokes or heart attacks.
6. Distrust in Medical Recommendations
Unfortunately, the healthcare system is facing growing challenges due to public distrust and hesitancy. This distrust has been fueled by misinformation and skepticism about prescription medications, often influenced by social media or online forums, as well as alternative medicine claims. Cultural injustices may also contribute to distrust among certain populations.
When patients question whether a recommended treatment is truly safe or necessary, transparent communication is the key to building trust. For example, physicians can review blood work or other diagnostic tests with patients, allowing them to see the impact of a condition on their health.
Additionally, providers can remain open to alternative recommendations for patients who are hesitant to take medication. For example, if a patient is experiencing high blood pressure, a provider may recommend lifestyle changes and exercise.
The provider could suggest a follow-up appointment in one to two months to assess the patient’s symptoms and determine whether the lifestyle changes effectively addressed the medical concern. If they did not, the physician and patient could revisit prescription interventions.
7. Common Side Effect Concerns
Fear of side effects is a common reason patients avoid medications. Others will start to take a medication but discontinue it due to side effects, especially if they experience the following:
- Nausea
- Dizziness
- Fatigue
- Headaches
- GI distress
Physician communication and patient education are critical to addressing this issue.
Providers should discuss common side effects that patients may experience as their bodies adjust to the medication. For example, statins are known to cause GI distress, nausea, and diarrhea in the first few days. If patients are aware of these potential effects ahead of time, they may be willing to give their bodies time to adjust.
When a patient stops taking a medication because of unexpected side effects, it is often harder to convince them to restart it. A transparent approach is always best.
8. Fear of Long-Term Risks
Some patients are worried about the long-term effects of medications. Common long-term concerns include dependency, organ damage, or chronic side effects.
For example, some individuals avoid taking opioids for fear of addiction or refuse statins due to worries about liver damage. These fears are often fueled by anecdotal accounts or misinformation.
Providers must be honest about the risk factors associated with a medication. However, they also need to help patients conduct a risks-versus-benefits comparison. When patients understand the very real (and often likely) repercussions of nonadherence, they may decide that taking a medication is in their best interests despite the risks.
Conducting regular check-ins is also important in resolving patient fears. When clients understand that their providers will periodically assess how they are responding to the medication, they may be less concerned about long-term risk factors.
9. Forgetfulness or Busy Lifestyles
People are busy, and medications aren’t always at the forefront of patients’ minds. Adults who are juggling multiple responsibilities and older patients with complex medication regimens tend to be the most forgetful when it comes to taking their prescriptions.
Providers can suggest some basic strategies for improving clinical outcomes. For example, purchasing pill boxes and setting out all medications for the week can help forgetful patients stick to their treatment regimens. Reminder apps or alarms can also help patients remember what medications to take and when they are supposed to take them.
Physicians should also encourage patients to integrate medications into their daily routines. If a patient is struggling with adherence, a quick brainstorming session can often lead to a solution.
For example, suppose that a particular patient eats breakfast at the same time every morning. A doctor may instruct that patient to take all of their a.m. medications with breakfast. However, another patient frequently skips breakfast. They might instead take their medications just before brushing their teeth.
When taking medications is integrated into a person’s routine, there is a lower risk that they will skip doses or forget to take their prescriptions.
10. Mental Health Challenges
Individuals who are dealing with depression, anxiety, or cognitive impairments may struggle to take their medications as prescribed. For example, a patient suffering from depression may feel unmotivated to follow through with their treatment regimen. Older adults in cognitive decline may unintentionally skip medications due to forgetfulness or confusion.
Providers should consider each patient’s individual needs when creating treatment plans and prescribing medications. Getting family members or caregivers involved early may promote better adherence. Those facing mental health challenges may benefit from more personalized interactions or frequent follow-ups.
Physicians should also explore supplemental resources for patients with mental health challenges. For instance, a patient who has been diagnosed with depression may benefit from a combination of services. They can talk to their primary care physician or therapist regularly about following through with medication. Community resources such as support groups can also be valuable.
11. Transportation or Pharmacy Access Issues
A lack of pharmacy access disproportionately impacts individuals in rural communities. Drug Topics reports that only 60% of rural census districts have access to a pharmacy within a 10-minute drive. A patient who doesn’t own a car or can’t drive can face serious barriers to healthcare access, especially if they live in a rural or underserved community.
Providers should talk to their patients to discuss pharmacy accessibility and offer solutions to those with limited access.
When possible, providers can push for patients to receive three-month supplies of medications. Additionally, physician dispensing allows patients to receive medications at their provider’s office so that they can avoid an additional trip to the pharmacy.
12. Medication Shortages
Supply chain disruptions and manufacturing delays can create shortages of critical medications. When this happens, many patients cannot adhere to their treatment plans. Shortage-related noncompliance is a particularly difficult problem to address, as it is often out of the patient’s and provider’s control.
Physicians and pharmacies can work with pharmaceutical companies to plan for shortages. One option is to compose a list of viable substitutes for critical medications so that patients can continue their treatment regimens.
Solutions for Improving Medication Adherence
A lack of follow-through with medications has several potential causes. Likewise, addressing the underlying causes of low adherence rates requires a multifaceted approach. Here are some ideas.
Improved Patient Education
Poor health literacy represents a major barrier to medication adherence. If patients don’t understand why a medication is necessary or what the risks of nonadherence are, they may skip doses or stop prescriptions without discussing the matter with their provider.
Physicians play a key role in educating patients. They should use plain language and schedule follow-up consultations to ensure patients understand their prescriptions.
Leveraging Technology
Most patients want to follow their treatment plans, but they might need a little help. Digital tools, such as medication reminders and mobile apps, can help these patients stay on track.
After conducting some research on these tools, a provider can create a list of recommended apps and offer guidance on how to use them.
Building Stronger Patient-Provider Relationships
Trust and empathy can foster adherence. Providers who take the time to understand a patient’s point of view and work collaboratively to create a personalized care plan can build a strong relationship with that patient.
Doctor dispensing is one way to cultivate stronger patient-provider relationships. Under this dispensing model, prescribers dispense new medication directly in the office. This strategy combats patient nonadherence by removing accessibility barriers.
Additionally, providers can use this opportunity to provide more direct patient care and discuss the risks of medication nonadherence. When a patient understands the importance of following their treatment plan, they may be more likely to follow their medication regimen.
Bridge the Gap to Patient Adherence With Proficient Rx
Medication adherence is a complex problem that requires a modern solution. As a healthcare provider, you can lead the charge toward improved patient outcomes. Proficient Rx, a leader in physician dispensing technology, will help you centralize medication dispensing to improve adherence and promote informed decision-making.
Contact Proficient Rx to learn more about our physician dispensing solutions and how they may help your practice reduce noncompliance.