Understanding Medication Non-compliance - Why Patients Don't Take Their Medicine (and What Can Be Done About It)

The days of “Take two of these and call me in the morning” are long gone. Today's medications are much more complex – and much more effective. But they only work when patients take them as directed. Unfortunately, as many as half of all patients in developed countries aren't taking their medications properly, according to the World Health Organization (WHO).[1] And the results are more than a little unsettling.

A study released in 2009 by the New England Healthcare Institute (NEHI)[2] showed that medication non-compliance, also known as non-adherence, costs the U.S. health care system an estimated $290 billion every year in avoidable expenses. The impact on patient health is even more alarming. “Non-adherence with medications and treatment plans is a significant problem for patients, particularly those with multiple chronic illnesses, many of which require lifelong treatment to improve health outcomes,” says Dr. Peter Gonzales, an internist and primary care doctor at Beth Israel Deaconess Medical Center in Boston. Pharmacist Adam C. Welch, who is also an associate professor at Wilkes University, agrees: “In the pharmacy, I see people who cannot get their diseases under control, which may be a result of non-adherence. This can put them at risk for more serious complications down the road.

Indeed, medication noncompliance may be responsible for:

  • As many as 125,000 deaths annually from cardiovascular diseases such as heart attack and stroke
  • Up to 23 percent of admissions to nursing homes
  • 10 percent of hospital admissions[3]

And that's not even taking into account the many doctor's visits, tests and treatment procedures that otherwise may have been avoided.

With so much at stake, experts are clamoring to find ways to address this problem. The first step is getting to the heart of the issue – just why do so many patients fail to take their medications as prescribed? While it would be impossible to pinpoint a single reason universal to all non-compliant patients, several factors have emerged as key concerns. “There are many contributing factors,” notes Gonzalez. “Some are related to our health care delivery system, and some are more associated with individual patient preference, understanding, literacy, cognition, side effects and support systems.” Welch concurs, noting, “Non-adherence can be for a variety of reasons: the medication regimen can be complex, they may not have access to the medications because of cost, or they may have certain beliefs about the medication or certain adverse effects.”

Affordability and accessibility

Whether paying out-of-pocket for medications or navigating the ever-changing realm of prescription insurance coverage, the bottom line for a lot of consumers is money. “From a health care system perspective, the cost of medications including co-payments and the unavailability of low cost generic medication alternatives is a significant cause for patients not taking medications regularly,” says Dr. Gonzales. “When money is scarce medications are often sacrificed in lieu of other necessities.”

A 2001 Harris Interactive telephone poll[4] found that, among a sample of 1,010 adults, because of cost:

  • 22 percent had not filled at least one prescription during the previous year
  • 14 percent had taken a prescription in smaller doses than prescribed
  • 16 percent had taken a medication less frequently that prescribed

Noncompliance was higher among lower income groups and was worse in the United States than in other countries.

Considering the high price of noncompliance, making medications more affordable and accessible will be increasingly important as the Baby Boomer generation ages, increasing the percentage of people living with chronic conditions, and leans more heavily on the health care system. “Changing the way we finance our health care system – making medications affordable to an aging population – is absolutely necessary,” states Dr. Gonzales.