Adherence to Medication

Most obviously, if a person does not adhere to treatment, symptoms may not be relieved or the disorder may not be cured. However, not adhering may have other serious or costly consequences. Not adhering is estimated to result in 125,000 deaths due to cardiovascular disease (such as heart attack and stroke) each year. In addition, it is thought that up to 23% of nursing home admissions, 10% of hospital admissions, and many doctor visits, diagnostic tests, and unnecessary treatments could be avoided if people took their medications as directed.

Not only does not adhering add to the cost of medical care, it can also worsen the quality of life. For example, missed doses can lead to optic nerve damage and blindness in people with glaucoma, to an erratic heart rhythm and cardiac arrest in people with heart disease, and to stroke in people with high blood pressure. Not taking all prescribed doses of an antibiotic can cause an infection to flare up again and may be contributing to the problem of drug-resistant bacteria (bacteria that no longer respond to usual antibiotics).

Children are less likely than adults to take medications as directed. For children with chronic diseases such as type 1 diabetes or asthma, adherence is difficult to achieve because their treatment plan is complex and must be continued for a long time. Getting children to take medications that do not taste good, seem frightening (such as eye drops or those that require a mask over the face), or require injections can also be difficult.

Sometimes parents do not understand a doctor's instructions. Also, parents (and patients themselves) forget much of the information they are given shortly after meeting with a doctor. They remember the first part of the discussion best and remember more about diagnosis than about the details of treatment. That is why doctors try to keep the treatment plan simple and often provide written instructions.

Although adherence is probably not affected by older age itself, it is affected by several factors that are common among older adults, such as general medical or behavioral health conditions or the use of more medications, and an increased risk of drug-drug interactions and side effects. Taking several medications makes remembering when to take each medication harder and increases the risk of adverse drug-drug interactions, particularly when over-the-counter medications are also being taken. Doctors may be able to simplify the medication regimen—by using one medication that serves two purposes or by reducing the number of times a medication must be taken—to improve adherence and to reduce the risk of interactions.

Because older adults are generally more sensitive to medications than younger people, they are more likely to have adverse drug reactions and may require a lower dose of certain medications (see Aging and Medications).

People are more likely to adhere to treatment if they have a good relationship with their doctor and pharmacist. Such relationships involve two-way communication.

Communication can start with an information exchange. By asking questions, doctors can help people come to terms with the severity of their disorder, intelligently weigh the advantages and disadvantages of a treatment plan, and ensure that they understand their situation correctly. By discussing their concerns, people can learn that denial of their disorder and misconceptions about their treatment can lead to forgetting to take medications as directed, resulting in unwanted effects. Doctors and pharmacists can encourage adherence by providing clear explanations about how to take the medications, why the medications are necessary, and what to expect during treatment. When people know what to expect from a medication, good or bad, they and the health care professionals involved in their care can better judge how well the medication is working and whether potentially serious problems are developing. Written instructions help people avoid mistakes caused by poor recall of their discussions with the doctor and pharmacist.

Good communication is important, particularly when people have more than one health care professional, because it ensures that all professionals know all the medications prescribed by the others, and an integrated treatment plan can be developed. Such a plan can help reduce the number of side effects and drug-drug interactions and possibly result in a simpler medication regimen.

Participating in decisions about their treatment plan makes people more likely to adhere to it. By participating, people take responsibility for the plan and are therefore more likely to follow it. Taking responsibility includes helping monitor the good and bad effects of treatment and discussing concerns with at least one of their health care professionals. Even if the health care professional does not ask, people should report unwanted or unexpected effects rather than adjust a medication dose or discontinue a medication on their own. When a person has good reasons for not following a plan and explains them, the doctor or other health care professional can usually make an appropriate adjustment. It is wise for people to keep an up-to-date list of all of their medications and to take it with them to any health care appointments.

Believing that their health care professional cares also makes people more likely to adhere to the treatment plan. People who receive explanations from a concerned health care professional are more likely to be satisfied with the care they receive and to like the health care professional more. The more people like the health care professional, the more likely they are to adhere.

Obtaining all medications from one pharmacy can also help, because pharmacists keep computerized records of the medications a person is taking and can monitor them for possible duplication and for drug-drug interactions. People taking prescription medications should inform their pharmacist about what over-the-counter medications and dietary supplements (such as medicinal herbs) they are taking. Also, people can ask the pharmacist about what to expect from a medication, how to take it correctly, and which medications interact with each other.

Support groups for people with particular disorders are often available. These groups can often reinforce the importance of following a treatment plan and provide suggestions for coping with problems. Names and telephone numbers of support groups can be obtained through local hospitals and community councils.

Memory aids can help people remember to take their medications. For example, reminder cards can be placed in different areas of the home, or taking a medication can be associated with a specific daily task, such as brushing teeth. A wristwatch that beeps can be used as a reminder of when to take a medication. A health care professional or the person can mark the medication dose and the time of day to take it and the person can mark it on a calendar. When the medication is taken, the person checks the appropriate space.

Containers that help people take medications as instructed can be provided by a pharmacist. Daily doses for a month may be packaged in a blister pack marked with calendar days, so that people can keep track of doses taken by noting the empty spaces. Caps or stickers the same color as the tablet or capsule can be placed on each container to help people match the medication to the instructions on the container. Multicompartment medication organizers that contain compartments for each day of the week and/or for different times of each day can be used (see Drug Errors). The person or caregiver fills the compartments on a regular basis, such as at the beginning of each week. By looking at the organizer, the person can determine whether the pills have been taken.

Containers with a computerized cap are available. These caps beep or flash at dosing time and can record how many times a container is opened each day and how many hours have passed since the last time the container was opened. Another alternative is a paging service with a beeper (available from subscriber-based telecommunications companies).