Why don’t people take their prescribed medicines as directed?

Poor adherence to medication undermines patient health and inflates healthcare costs.  
 
When a patient does not take their medicines as prescribed by their doctor:  

• the health benefits of the medicine are lost
• the patient’s treatment balance deteriorates
• the need for unnecessary visits to the doctor and treatment increases
• the money spent by society and patients on medicines is wasted
• unnecessary pharmaceutical waste is generated.

Kirsi Kvarnström, a pharmacist, PhD(Pham), at HUS Pharmacy, studied patient adherence to medication in her doctoral thesis. She looked for reasons why people do not take their prescribed medicines as directed. It turned out to be a complex problem. 

Side effects are a concern, benefits remain unclear

Only about half of the people with chronic conditions take their medicines as intended. Often, non-adherence to medication is the result of the patient not knowing enough about their treatment or where to get answers to the questions they have.  
 
Kirsi Kvarnström found many reasons for why people did not adhere to their medication:  

• The patient is not sure about the benefits of the medicine. If a disease does not cause specific symptoms, it may be difficult to understand its severity. For example, hypertension may have very few symptoms, and the patient may not understand how important it is to take the medicine.
  
  
• When a patient is concerned about the side effects of a medicine, they may not take it at all or they may take it less often or at a smaller dose.  
  
  
• If a medicine is substituted with a generic at the pharmacy this may affect adherence if the patient has doubts about the generic product.
  
  
• The medication is difficult to fit into daily life. Patients may easily forget to take their medicines if taking them does not become a routine.  
  
  
• The patient is still adjusting to the fact that they have a chronic condition, and coming to terms with the diagnosis is taking time. The patient may think that the medication is something temporary and they may not understand the fact that they will have to take the medicine for the rest of their life.  

Pharmacists have an important role  

The patient is the key factor in the medication. It is therefore important to set aside sufficient time for engagement.  
 
“Patients are experts of their own daily lives. They will know what is preventing them from taking their medicine,” says Kvarnström.  
 
It is important for the doctor to make sure that the patient understands why the medicine is being prescribed and what are the consequences of not taking it. Side effects should also be discussed.  
 
The doctor can also work with the patient, if necessary, to find a medication that is best suited to the situation if the patient works irregular shifts, for example.  
 
Patients should be given clear advice on whom to contact if they have problems with their medicines.  If the patient has a healthcare professional, they can talk to about their concerns this will improve adherence to the medication.  
 
Kvarnström also stresses the importance of pharmacies – after all, patients visit pharmacies more often than doctors. Pharmacists are experts on medicines and can provide advice on their correct use. People often find it easier to talk to a pharmacist than a doctor about problems with medication. 

Assessment of medication situation in connection with doctor’s appointments

Healthcare resources are stretched and must be used more efficiently. There are various solutions that can ensure that even when doctors are busy, patients will be heard and any problems related to medication can be solved.   
 
For example, for years HUS has been using a well-established model where an outpatient clinic pharmacist will determine the patient’s medication taken at home before the doctor’s appointment. If necessary, the pharmacist will give advice on the medication and resolve any misunderstandings.  
 
“This is particularly useful for patients with multiple illnesses who take multiple medicines,” says Kvarnström. 

Medication is our common cause 

It is in everyone’s best interest that people adhere to their medication. In our various roles, we can influence adherence to medication prescribed by a doctor:  
 
Decision makers

• should be aware of the costs of non-adherence to medication

Media

• should provide reliable information on medicines and raise public awareness of the problems related to medication 

Pharmaceutical companies  

• should ensure medicine is easy to use and has clear labelling and instructions for use  

Patient’s relatives and friends  

• should support the patient in matters relating to their medication and encourage them to contact a healthcare professional  

Patient  

• should talk openly about their medication to their doctor or pharmacist.