The problem of non-adherence to medication carries much weight within the healthcare sector. When patients fail to take their medication—diligently—not only they risk disease relapse, such action would also lead to unnecessary waste of medication and a higher cost of treatment.

However, in our quest to drive down the proportion of non-adherence among patients, our focus commonly narrows down to elderly patients or those without satisfactory dexterity to adhere to the treatment. Our myopic vision has, unfortunately, obscured the looming problem in a population at the opposite end of the spectrum: the millennials.

How prevalent is the problem?

A newly published report by Express Script on adherence to diabetic medication among the commercially insured Americans revealed that just under half of all patients, aged between 20 and 44, were completely adhering to their oral anti-glycemic medications. Compared to their elderly counterparts, adherence among patients aged 65 or older was at nearly 75%.

Other contemporary studies on treatment adherence among adolescents and young adults also indicate a perturbing trend. Depending on the method of assessment, the rates of adherence in these young patients vary significantly from 10% to 89%.

Such wide variations may be attributed to multiple factors. Nonetheless, a particularly interesting trend has emerged from one of the studies which examined the different methods of reporting adherence among asthmatic patients. The researchers discovered that self-reporting – either by the children or mothers – were significantly over-estimating the adherence rate compared to the figures recorded via electronic doser or canister weight.

An older report, published in 2013, has coined these young adults who had a high tendency to quit taking their medication or never fill their prescription in the first place as the "invincible generation". The fact that just under half of these "invincible" young adults said they would rather pay for gas for their car than paying for prescription medicine is sufficiently worrying and deserves thorough investigations.

Understanding the root cause

The origin of the adherence problem may be multifactorial, intertwined causal factors of personal belief, familial and socioeconomic considerations, the severity of disease, complexity of treatment and a tinge of the rebellious spirit that is typical of people within this age group.

The critical factor for healthcare providers to consider then, is the developmental process these patients are experiencing – especially those who are still going through their adolescent years. These arguments are neatly summarised by Taddeo, Egedy and Frappier in their 2008 paper titled "Adherence to treatment in adolescents".

The paper states that “young teenagers will mainly believe what they can see or have experienced and, thus, they cannot fully appreciate the long-term or unseen consequences of not taking their medications… at times of stress (such as an illness), adolescents may regress to more simple ways of problem solving”.

“Psychologically, people tend to prefer actions that offer short-term benefits but most chronic medications provide no short-term benefits – only short-term annoyances. So, people may skip taking or stop refilling their medication altogether even if the long-term risks to their health are enormous. That's the reality of medication non-adherence that needs to be addressed,” remarked Dr Katrina Firlik, co-founder and chief medical officer of HealthPrize.

The bottom line

There is no straightforward or simple approach to solving the adherence problem among the young adult populations. Though, there are multiple ways of improving adherence – but, health care providers must first establish construction dialogues to understand the underlying causes. Coordinated care, between prescribers, pharmacists and patient family members, stands the best chance to deliver a satisfactory outcome in these instances. MIMS

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