While 48% of Americans routinely take at least 1 drug daily, older patients (over the age of 60) use prescription drugs more commonly, with about 75% of patients taking 2 or more and 40% taking 5 or more prescription drugs every day.1,2 Yet, adherence to physician prescribed medication regimens treated for chronic conditions is only about 50%.3-5Problems include failing to fill or refill prescriptions, omitting doses, overdosing, prematurely stopping, and taking medications prescribed for someone else. About one-third of elderly patients never comply with their medications, and more than half make errors when taking their medications.
Numerous factors contribute to failure to adhere to a prescribed medication regimen or treatment plan. Patients often do not understand the rationale for the medication nor the intended benefit. The regimen may be too complex to follow. Medication side effects or patient’s lifestyle may also disrupt adherence. Many patients cannot afford their medications and will adjust their regimen by skipping or adjusting doses. Finally, many patients simply forget.4,5
This failure to follow medical direction gives rise to some 125,000 deaths annually in U.S. As many as two-thirds of all medication-related hospital and nursing home admissions result from poor medication adherence. This increase in Emergency Department care, physician office visits, additional diagnostic tests, alternative treatments, and adverse clinical outcomes adds an estimated incremental $290 billion to annual U.S. healthcare expenditures .4,5
AF is a chronic condition that requires long-term management with heart rate control or rhythm control medications in addition to anticoagulants. Presently, oral anticoagulant options include warfarin, dabigatran, apixaban, and rivaroxaban and edoxaban. For these agents to be effective in reducing stroke risk, they must be taken every day. Furthermore, patients will not perceive any benefit (prevention of a stroke) while they take the medications but may experience unwanted effects, most notably bleeding. The patient, and or a family member, must be empowered to take ownership in their medication management. Strong clinician and patient relationships remain the cornerstone to success. Clinicians should provide disease and medication education at each interaction. Pharmacists can simplify medication regimen complexity by combining medication administrations and associating them to a daily event (meals, sleep time, awakening, etc.).6 Other strategies that have been successfully employed include medication diaries, calendar pillboxes, and cell phone alerts.
In summary, lack of patient adherence to prescribed medications commonly limits safe and effective disease management. There are a wide variety of reasons and no single strategy for success. Clinicians must exercise vigilance for signs of non-adherence, offering patient and family education, support, and a wide range of strategies to maximize long-term adherence.
1. Centers for Disease Control and Prevention. US Prescription Drug Data. 2014; http://www.cdc.gov/nchs/data/databriefs/db42.htm. Accessed 12 May, 2014.
2. Centers for Disease Control and Prevention. Health United States 2010. 2014; http://www.cdc.gov/nchs/data/hus/hus10.pdf. Accessed 12 May, 2014.
3. Office of Inspector General. US Department of Health and Human Services. Medication Regimens: Cause of Non Compliance. 2014; http://oig.hhs.gov/oei/reports/oei-04-89-89121.pdf. Accessed 12 May, 2014.
4. Osterberg L, Blaschke T. Adherence to medication.N Engl J Med.2005;353(5):487-497.
5. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost.Med Care.2005;43(6):521-530.
6. Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).Chest.2008;133(6 Suppl):546S-592S.
John Fanikos, RPh, MBA, talks briefly about medication adherence and ways to improve medication taking behaviors: