In a 2003 report, the World Health Organisation (WHO) stated that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than improvements in specific medical treatments.

The UN health body further expressed that a low-cost intervention for improving medication adherence is more cost effective than treating an illness that is caused by non-adherence to medication. This is due to the fact that poor adherence to medication compromises treatment outcomes and increases patient mortality.

Therapeutic compliance is not a new issue but has been debated since 1970, due to the widespread nature of this issue. It includes compliance to medication, diet, exercise, lifestyle changes or any changes as advised by a physician.

These are a few reasons for medication non-compliance among patients:

Lack of motivation

A study done in Malaysia found that 85% of hypertensive patients mentioned the lack of motivation as the reason for dropping out of treatment. This may be quite common especially in a long-term and complicated regimen of medication.

Lack of motivation is quite tricky to prevent as it is due to several factors. It may be caused by lack of patient’s understanding of the importance of medication, such as when the patient believes that the medication did not work, or that the medication did not meet the patient’s expectations. Sometimes, patients may also lack social support, which may lead them to drop out of treatment.

It is essential that the doctor finds out the reason behind the lack of motivation in the patient before planning any measure or action.

Forgetfulness and negligence

Forgetfulness is a widely reported factor to non-compliance with medication or clinic appointments. Elderly patients or those suffering from neurological disorders such as dementia may have a memory problem that hinders them from complying with medication instructions.

On the other hand, patients below 30 and 40 years old may have many priorities, work and other commitments which cause them to neglect their medication or clinical appointments. This was shown in a study done in Singapore, where patients who were less than 30 years of age were found to be less likely to collect the medication that was prescribed at a polyclinic.

Health illiteracy and misconceptions

Health literacy refers to the degree of which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Patients with low health literacy are reported to have a low adherence to medication. In the US alone, 90 million adults are estimated to have inadequate health literacy.

The misconception among patients regarding their treatment, medication or disease may result in distrust in the therapeutic regimen. Needless to say, this misconception often leads to poor adherence to medication. For example, according to a survey among hypertensive patients in Malaysia, many believe that “western” medication is harmful if used in the long term.

Complicated medication regimen

A complex therapeutic regimen may lead to increased non-compliance to medication; this is an expected trend, considering that these patients need to take a considerably longer amount of time to sort out their medication each day.

A study found that non-compliance increased with an increase in the frequency of prescribed dosing: 20% for once daily; 30% for twice daily; 60% for three times a day; and 70% for four times daily. Another study among hypertensive patients found that adherence to a thrice-daily medication regimen was only 59% compared with about 84% for a once-daily regimen. Both of these studies imply that a doctor should take a simplistic approach whenever possible.

Doctors also should note that a longer period of medication may result in reduced patient compliance. In a tuberculosis study comparing preventive regimens of three, six and twelve months, compliance rates were 87%, 78% and 68% for the three regimens, respectively.

Ultimately, it is important for health providers to know the reason behind low patient compliance to medication, so that the approach that is taken will be an effective one. MIMS

Read more:
How to improve patient compliance for medications
The persistent problem of non-adherence to medication
A patients’ perceptions of their illness matters