Medication non-adherence is a worldwide problem. The term adherence is usually used synonymously with compliance, albeit there is a difference between both terms.

Patient compliance refers to patients’ obedience to the doctor’s authority, and it implies a paternalistic role for a doctor and a passive role for a patient. Adherence, however, refers to a patient himself or herself being constant with the medication. This term reflects a more active part of the patient himself or herself rather than an assertive doctor’s role to push medication on them.

However, both terms are usually used interchangeably in research and medical literature. According to WHO, medication adherence is defined as the degree to which the person’s behavior corresponds with the agreed recommendations from a healthcare provider.

WHO also reported that adherence to medication for chronic diseases is around 50% in developed countries and that this figure is even worse in developing countries, for many reasons such as poor accessibility to medication and health services. This is a cue for immediate action.

Types of non-adherence

There are a few types of non-adherence, although researchers are seemingly not in agreement with them.

1) Primary non-adherence

Primary non-adherence refers to not filling a prescription. In this type of non-adherence, a patient never initiates the medication after they have been prescribed by a health provider. It is also known as non-fulfillment.

2) Non-persistence (intentional and unintentional)

The second type is referred to the patient choosing to stop taking medication without any advice from a health professional to do so. It may be intentional or unintentional. Most often, it is intentional due to the patient’s beliefs or his distrust towards the treatment provided.

3) Non-conforming

Non-conforming patients refer to any behavior or variety of ways of not being constant with medication. It may include skipping a dose, taking more medication than prescribed or not taking it at the correct time.

However, the various types of non-adherence to medication usually overlap and cannot be clearly classified. Researchers also propose another classification which broke down adherence into initiation, implementation, and discontinuation.

Initiation refers to when a patient takes the first dose of medication; implementation is the duration of a patient taking the medication; discontinuation is when the patient stops taking the medication. So each stage requires a tailored approach to avoid any non-adherence along the way.

Various risks as a consequence

Needless to say, non-adherence of medication will deteriorate diseases progression and reduce the quality of life of a patient. Research found that non-compliance is directly associated with poor treatment outcomes in patients with diabetes, epilepsy, HIV-AIDS, asthma, tuberculosis, hypertension, and organ transplants.

Health providers also suffer from patients’ non-adherence. It was shown in a study that the risk of hospitalisation was more than double in patients with diabetes mellitus, hypercholesterolemia, hypertension, or congestive heart failure that were nonadherent to prescribed therapies in comparison to the general population.

Non-adherence to medication will lead to worsening disease progression, and hence, increased use of medical resources, not to mention a waste of medication in the first place. This was clearly shown in the US and Australia hospital admission, where 33% to 69% and 25% of hospital admission were due to non-compliance with treatment regimen respectively.

Moreover, non-adherence to medication also can affect the study done to evaluate the value of medication in a particular target population. This may have an effect in future health planning since that particular research does not reflect an actual data or statistic as it is supposed to.

All in all, the issue of non-adherence needs to be formally addressed both at national and global levels. Additionally, solving this issue will not only be profitable in the future and time-saving in stopping the disease progression but, more importantly, will improve patient wellbeing. MIMS

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