Chronic Illness And Disability

Introduction to paper discussing the prevalence of medication non-adherence among patients with chronic diseases

This paper discusses the prevalence of medication non-adherence among patients with chronic diseases. Medication non-adherence is a common problem with adverse effects on the healthcare system (Kleinsinger, 2018). The impact of non-adherence on clinical outcomes and economic costs will be discussed. The factors that are responsible for non-adherence will be outlined. Patient-related factors will be further discussed and strategies to address those will be provided. Methods to assess the efficacy of these strategies will be listed.


As life expectancy is rising due to increased healthcare, a great number of people are living with a chronic condition, many times with multimorbidity(Hopman, et al., 2016). Multimorbidity is that condition in which two or more long term conditions are present in the same person. According to Hopman et al (2016), multimorbidity is especially present in people of age above 65, with high occurrence in those above 85. However, multimorbidity is also increasingly affecting less older population group. According to Lai et al. (2019), there are more absolute numbers of less older multimorbid adults than higher age multimorbid adults.

These patients require multiple medications and in fact, data suggests that the use of 3 or more medications have increased(Fredericksen et al., 2018). The authors suggest that as the number of prescribed medicines increases there is an increased tendency to not adhering to medication regime. Medication adherence is the patient’s practice of following a recommendation by medicine prescriber. In about 50 percent of cases of chronic diseases, there is non-adherence (Cutler et al., 2018).Thus with chronic diseases and with multiple diseases as the number of medicines increases so does the tendency of non-adherence.

Consequences of Medication Non-Adherence

Non-adherence increases the burden on the healthcare system. Cutler et al. (2018) gives the data that there is an increased cost of 7 billion Australian dollars due to non-adherence. Additionally, they give data that typical non-adhering patient requires additional 3 medical visits per annum compared to adhering patient. Many studies show that medicine non-adherence is associated with poor clinical outcomes. In a systemic review for depressive patients by Ho et al.(2016), it is concluded that there exists a strong association between worse clinical outcomes and non-adherence to medication.

They cite that those non-adherentpatients were more likely than adherent patients to have recurrence of depressive episodes, increase in hospitalization, increase in condition severity. These increased healthcare costs for this patients.Similarly; significant association was found between medication non-adherence and hospitalization rate and mortality in older patients (Walsh et al., 2019). Hence non-adherence does hurt clinical outcomes and healthcare costs.

Factors for Medication Non-Adherence

Many studies were undertaken to find out the factors responsible for medicine non-adherence. These factors can be classified according to WHO into five sets which are termed dimensions that are socio-economic dimension, patient-healthcare system dimension, disease condition dimension, therapy dimension, patient dimension(WHO, n.d.). According to WHO, these factors or dimensions’ mutual interactions together affect the adherence or non-adherence of medication.Patient factors which affect medication adherence can be sub-grouped under patient’s mental state, physical status, patient demographic, history of past illness, patient’s behaviour, attitude, habit, beliefs, knowledge and other conditions (Yap, Thirumoorthy, & Kwan, 2016).

Jin, Kim, & Rhie (2016) found medication adherence of older patients was linked with the level of education, other health linked problems, medicine dose frequency, level of satisfaction with counselling, and medication explanation. Depression affects adherence negatively(Gast &Mathes, 2019). Other factors that affect non-adherence aret, intellectual impairment, complicated medications prescribed by multiple providers, and the problem of medicine storage (Smaje et al., 2018).Forgetfulness is frequently mentioned reason for non-adherence (Seal, Cave, & Atkinson, 2017). Negative beliefs about medicines like becoming drug dependant and adverse side effects make patients non-adhering(Patient Engagement HIT, 2017).So to address non-adherence the interventions must be directed against these patient-initiated barriers.

Strategies for Medication Non-Adherence

Behavioural interventions

Behavioural interventions aim to change the patient’s behaviour towards treatment (Costa et al., 2015).In one intervention anurse provoked patients’ beliefs to strengthen their resolve to take medication regularly as prescribed. In a second interventional, the nurse asked patients to list the exact circumstances that will force them to take their medication.

Educational interventions

In this type of interventions, healthcare providers can overcome patients’ barriers by properly explaining the way to take medicine, by asking why the patients do not want to take medicine, and by discussion about their health and treatments(Ampofo, Khan, &Ibitoye, 2020).

Self-management interventions

Helping people to self-manage their health and care can have improvement in outcomes (Dineen-Griffin et al., 2019). According to the authors self-management support is more than an instructional program, it aims to bring about behaviour changes in a collaborative patient-provider relationship.Patient and health care provider (HCP) work together to set realistic healthcare goals, at the same time HCP helps patient to develop skills necessary to meet these goals and also regularly assesses the patient for improvement. The set of skills effective for self-management includes, problem-solving skill, decision making skill, effectively using resources, ability to form a professional relationship with HCP, and action taking skill. On acquiring these skills the self-efficacy of patient increases. This helps in achieving health goals(Dineen-Griffin, Garcia-Cardenas, Williams, &Benrimoj, 2019).

Methods to measure efficacy

Strengthened patient-nurse therapeutic relationships is the outcome of these strategies. These strategies will lead to increased adherence in patients. To measure adherence several methods can be used which includes, patient questionnaires, self-reports by patients, counting medicine, prescription refill rates from pharmacy, assessing patients clinical outcomes, electronic devices capable of monitoring, investigative reports from the laboratory, and so on(Al-Hassany, Kloosterboer, Dierckx, & Koch, 2019).

Conclusion on Medication Non-Adherence

It can be stated that medication non-adherence is a major negative factor which impacts the healthcare system. The adverse impacts of non-adherence are both clinically bad for patients and economically draining both for patients and the healthcare system. Patient-related factors have a major role in non-adherence. To address these factors, healthcare providers especially nurses can employ effective interventions. The strategies which seek to bring out changes in patient behaviour like counselling, education and patient self-management can be part of day to day healthcare.

References for Medication Non-Adherence

Al-Hassany, L., Kloosterboer, S. M., Dierckx, B., & Koch, B. C. (2019). Assessing methods of measuring medication adherence in chronically ill children–a narrative review. Patient Preference and Adherence,Volume 13, 1175-1189. doi:10.2147/ppa.s200058

Ampofo, A. G., Khan, E., &Ibitoye, M. B. (2020). Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart & Lung. doi: 10.1016/j.hrtlng.2020.02.039

Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., … Marengoni, A. (2015). Interventional tools to improve medication adherence: Review of literature. Patient Preference and Adherence, 9, 1303–1314. doi: 10.2147/PPA.S87551

Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open,8(1). doi:10.1136/bmjopen-2017-016982

Dineen-Griffin, S., Garcia-Cardenas, V., Williams, K., &Benrimoj, S. I. (2019). Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLOS ONE, 14(8), e0220116. doi: 10.1371/journal.pone.0220116

Fredericksen, R., Gibbons, L., Brown, S., Edwards, T., Yang, F., Fitzsimmons, E., . . . Crane, H. (2018). Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence. Research in Social and Administrative Pharmacy,14(6), 540-544. doi:10.1016/j.sapharm.2017.06.009

Gast, A., &Mathes, T. (2019). Medication adherence influencing factors—An (updated) overview of systematic reviews. Systematic Reviews, 8(1), 112. doi: 10.1186/s13643-019-1014-8

Ho, S. C., Chong, H. Y., Chaiyakunapruk, N., Tangiisuran, B., & Jacob, S. A. (2016). Clinical and economic impact of non-adherence to antidepressants in major depressive disorder: A systematic review. Journal of Affective Disorders, 193, 1–10. doi: 10.1016/j.jad.2015.12.029

Hopman, P., Bruin, S. R., Forjaz, M. J., Rodriguez-Blazquez, C., Tonnara, G., Lemmens, L. C., . . . Rijken, M. (2016). Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review. Health Policy,120(7), 818-832. doi:10.1016/j.healthpol.2016.04.002

Jin, H., Kim, Y., &Rhie, S. J. (2016, October 19). Factors affecting medication adherence in elderly people. doi: 10.2147/PPA.S118121

Kleinsinger, F. (2018). The Unmet Challenge of Medication Nonadherence. The Permanente Journal, 22. doi: 10.7812/TPP/18-033

Lai, F. T., Wong, S. Y., Yip, B. H., Guthrie, B., Mercer, S. W., Chung, R. Y., . . . Yeoh, E. (2019). Multimorbidity in middle age predicts more subsequent hospital admissions than in older age: A nine-year retrospective cohort study of 121,188 discharged in-patients. European Journal of Internal Medicine,61, 103-111. doi:10.1016/j.ejim.2018.12.001

Parekh, N., Ali, K., Stevenson, J. M., Davies, G., Krasteva, E., Schiff, R., . . . Rajkumar, C. (2019). 128Medication-Related Harm Due To Non-Adherence May Explain The

Relationship Between Polypharmacy And Mortality. Age and Ageing,48(Supplement_1), I37-I37. doi:10.1093/ageing/afy206.01

PatientEngagementHIT. (2017, May 12). Understanding Mental Barriers to Patient Medication Adherence. Retrieved May 15, 2020, from PatientEngagementHIT website:

Seal, F., Cave, A. J., & Atkinson, L. L. (2017). Primary Non-Adherence of Prescribed Pharmaceutical Treatments and Interventions: An Investigative Review to Improve Quality in Primary Care. Quality in Primary Care, 25(5). 

Smaje, A., Weston‐Clark, M., Raj, R., Orlu, M., Davis, D., & Rawle, M. (2018). Factors associated with medication adherence in older patients: A systematic review. AGING MEDICINE, 1(3), 254–266. doi: 10.1002/agm2.12045

Walsh, C. A., Cahir, C., Tecklenborg, S., Byrne, C., Culbertson, M. A., & Bennett, K. E. (2019). The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis. British Journal of Clinical Pharmacology, 85(11), 2464–2478. doi: 10.1111/bcp.14075

Yap, A. F., Thirumoorthy, T., & Kwan, Y. H. (2016). Medication adherence in the elderly. Journal of Clinical Gerontology and Geriatrics, 7(2), 64–67. doi: 10.1016/j.jcgg.2015.05.001

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