Drug Adherence is Problematic for All Save

The March 2017 issue of the ACP Internist has reviewed the ubiquitous practice of medication adherence. 

Consumer reports estimated that only 50% of new prescriptions are filled by patients.  Moreover, several data sources show that only 50% of patients with chronic diseases adhere to long-term therapies.  The problem is worse when you examine adherence 1-2 years later and even fewer patients remain on most needed therapies.

Patient forgetfulness or confusion only accounts for 30% of nonadherent behaviors.

Despite goals to improve this problem of nonadherence, there are few studies demonstrating succes.  Many believe it starts with better MD - patient relationships, and an effort to communicate the benefits of meds and the hazards of not taking the best available treatments. 

One of the many problems is that physicians have no clue who is compliant or not. Sometimes this is only uncovered when the patient "fails to respond" to the medication he/she has not taken.

In a 2005 review article in the New England Journal of Medicine showed measures to improve adherence have produced mixed results.  Even a 2014 Cochrane systematic review essentially came up empty remedies for the problem. 

Another 38 studies tested interventions that provided education and/or counseling, self-monitoring and/or feedback, and electronic reminders. Overall, about half of studies found improvement in adherence and outcomes.

RheumNow previously wrote about the importance of negotiation in patient care. This maybe be one effective measure.