10 Patient Barriers to Medication Adherence, With 5 Helpful Tools for Providers
By Richard Scott
July 31, 2012
Dr. C. Everett Koop might have said it best: “Drugs don’t work in patients who don’t take them.”
As health reform continues to push forward new models of care like the medical home, the rudimentary task of medication adherence remains a glaring problem. Roughly half of patients with chronic illnesses maintain “good” adherence to their drug regimen, according to the Health Resources and Services Administration.
This results in more than $290 billion in avoidable healthcare costs every year, stemming mainly from unnecessary emergency room visits, avoidable hospitalizations, and extra trips to the doctor’s office.
The good news is that new models of care like the medical home seek to end all the unnecessary utilization and improve patient’s well-being through more coordinated care, and many physician practices are in the process of formalizing their medical home models of care through accreditation, according to the New England Healthcare Institute (
NEHI). This has the potential to have a powerful effect on medication adherence, says NEHI: “Accreditation standards tighten and formalize medication management procedures and…require adherence-specific interventions.”
With vast dollars – and health – at stake, many eyes will remain on this slowly turning tide.
Prevalent Patient Barriers to Medication Adherence
There are a multitude of resources that provide education about the hot-button topic of medication adherence, and one of the leading publications is the Medication Adherence Project that was created by the New York City Department of Health and Mental Hygiene. The Medication Adherence Project applies a scope to provider, payer and patient populations in its quest to spell out the issue – and provide solutions for improvement.
The MAP program also identifies a comprehensive set of barriers that can result in poor medication adherence, including the top 10 barriers that lead a patient to poor outcomes. Ranging from physical reactions to behavioral issue, here is the top 10 list of patient barriers:
- Complexity. For patients with multiple conditions – and multiple drugs to take – complex regimens can lead to lack of adherence.
- High cost. The out-of-pocket costs of prescription drugs may lead patients to forego prescription refills, or may result in a patient deciding to take half of a pill, for example.
- Difficulty remembering schedules. Simply remembering when to take prescriptions can be a legitimate threat, particularly when multiple drugs are involved.
- Lack of understanding. If the patient does not understand the reason for taking a drug, he is more likely to stop taking them.
- Not feeling sick. When drugs have their intended effect, they can sometimes have the opposite effect on patients. If a patient doesn't feel sick, why take the drug?
- Side effects. Unwanted side effects can be a strong enough reason for many patients to halt their drug regimens.
- Embarrassment/Stigma. Some patients do not want others to know they are on prescriptions, while others may not want to admit their illness or condition.
- Depression. Many patients with multiple chronic illnesses face behavioral health issues, and conditions like depression can produce ambivalence.
- Health literacy. Drug-taking instructions, if not properly understood, can prevent a patient from fulfilling their doses.
- Belief systems. Patients may simply not buy into the benefits of prescription drugs, or they may be afraid of side effects.
5 Solutions for Augmented AdherenceWith the top barriers to medication adherence stated, the question becomes: What can providers do to spin the wheel in the other direction? The following resources, collected from health agencies and organizations around the country, are intended to promote high levels of medication adherence.
Medication Adherence Project: Toolkit and Training Guide for Primary Care Providers and Pharmacists
Massachusetts Coalition for the Prevention of Medical Errors: Med List
Adult Health Record
Quick Tips - When Getting a Prescription
For Providers: Tips for Conducting a Patient Medication Interview - from Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation (see page 40)Additional Resources from URACSupporting Medication Adherence: Ensuring Coordination, Quality and Outcomes
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