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Medication Non-Adherence: A Self-Inflicted Health Situation!

By Sunitha Anandan |

April 23, 2018

Do you know that in US alone 125,000 people are dying and more than 10% are hospitalized every year as they do not refill their medications or take them correctly? It is estimated that only 50% patients take their prescribed doses, whether it’s for a simple infection or a life-threatening condition. This lack of medication adherence is costing the US healthcare system between $100 billion and $290 billion annually. The cost burden is attributed to medication wastage, worsening of disease, reduced quality of life and increase in hospitalization.

Studies have shown that medication non-adherence leads to:

  • 89,000 premature deaths among hypertensive patients
  • 10% of medicare patients get readmitted to a hospital within 30 days
  • Unemployment, homelessness, and suicides amongst 41%-59% of mentally ill patients

“Drugs don’t work in patients who don’t take them”, stated former Surgeon General C. Everett Koop. Some new drugs that perform exceptionally well in studies fail to measure up once they enter the market, and many patients experience relapses or even die owing to non-adherence to prescribed medication.

By 2020 it is estimated that almost 90% prescriptions will be for generic drugs, and for these drugs adherence will be a bigger concern as compared to drug cost.

What leads to non-adherence to medications?

Medication adherence is affected by a variety of factors such as patient, provider and health systems, and interactions among them*.

Social and Economic

  • Limited language proficiency
  • Low health literacy
  • Unstable living conditions/homelessness
  • Lack of health insurance
  • Medication cost

Health care systems

  • Patient-provider relationship
  • Long wait times
  • Lack of care continuity
  • Restricted formularies

Condition related

  • Lack of Symptoms
  • Severity of Symptoms
  • Depression
  • Psychotic disorders

Therapy related

  • Complexity of the medication regimen
  • Duration of therapy
  • Frequent changes
  • Actual or perceived side effects

Behavior related

  • Visual, hearing, cognitive impairment
  • Knowledge about disease
  • Perceived risk/susceptibility to disease
  • Perceived benefit of treatment
  • Motivation and confidence

Patient-physician discord is stated to be one of the major reasons for non-adherence. Studies report that over 60% patients could not correctly report the directions provided by their physicians or misunderstood the doses or schedules prescribed.

In a large-pilot study conducted by Express Scripts in 2011, inattention and procrastination by patients accounted for over two-thirds of non-adherence– 39% of them forgot to take their medications, 20% failed to renew their prescriptions on time and 10% procrastinated on getting their refills.

It was estimated that non-adherence rates are high when patients are symptom-free. High degrees of compliance were noted by 77% patients when the treatment was designed to cure a disease than it was aimed at prevention (63%).

Improving Adherence through Patient Engagement

The rates of adherence can be improved through multiple strategies across the continuum of care and amongst them engaging patients in their health is a promising way to promote medication adherence.

Behavioral analytics and integrated data systems can help understand what nudges can better engage patients in their disease management. OSG’s Dynamo enables pharmaceutical companies to increase patient engagement through behavioral analytics, and allows the allocation of right resources to the right patients at the right time! Contact us now to find out more. Write to


*Source: Sabate, Eduardo. Adherence to long term therapies: Evidence for action, World Health Organization, 2003.

NEJM Catalyst( @ Massachusetts Medical Society

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