Types of Non-adherence and reasons why patients do not adhere

Medical Adherence: the extent to which patients take medications as prescribed by                                                  health care providers.

• Up to 40% of the population fail to adhere to medical advice.
• 125,000 people die every year due to failure to comply.

Types and extent of non-adherence

Clarke (2013) noted there are four types of adherence, which were turned into non-adherence types:

1. Not following short-term advice
2. Failing to attend a follow-up interview // referral appointment 
3. Refusing to make a life-style change.
4. Failing to take preventative health measures.

Rational non-adherence

Some patients do not adhere to medical advice after making a rational judgement, and find that there are more costs/risks than benefits of the treatment.

Lada, brien and Jan (2012) studied a community of sample patients in Australia and measured the importance of 8 medication factors through an online survey. The factors were put in order of the most important (1) to least important (8):

1. Immediate medication harm 
2. Immediate medication benefit
3. Long-term medication harm                                    
4. Long-term medication benefit 
5. Cost of treatment 
6. Regimen of treatment 
7. Symptom severity 
8. Alcohol restrictions  

It was concluded that adherence was affected by the way the treatment was sold to patients. E.g. using words like ‘therapeutic benefits’ rather than ‘side effects’ would increase compliance.

BULPITT AND FLETCHER (1988) found out that when the costs of taking medication outweigh the benefits of treating the problem, mainly asymptomatic ones, patients are less likely to adhere. 

It was discovered that the main side effects of medication for hypertension were:

• Sleepiness
• Laziness 
• Impotence 
• Weakened cognitive functioning.

For more detailed information – Bulpitt and Fletcher (1988)

Customising Treatment 

Patients modify treatments to suit their individual needs and preferences.

JOHNSON AND BYTHEWAY (2000) carried out research and concluded that older people are more likely to buy over the counter medication without prescription.

4 categories of medication was found to be more frequent:

1. Prevention and maintenance – vitamins
2. Doctor’s alternatives for issues like headache/indigestion.
3. Replacements for prescriptions medicines – painkillers.
4. Medicine to counteract the side effects of prescribed medicines.