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Feature Article: Managing Medication Adherence

(from the March 2017 ACP Internist)

That most nonadherent patients are willfully rejecting doctors' orders might seem shocking. But physicians have to accept it in order to encourage patients to accept their advice. Digital health tools may offer potential aids in solving matters of adherence.

For many physicians, prescribing medications is the easy part. The real challenge comes afterward.

Patients must ultimately decide whether or not to actually take what they're prescribed, and a startling proportion chooses to decline. About 50% of patients with chronic diseases adhere to long-term therapies, according to the World Health Organization. Even after acute myocardial infarction, only about 40% to 45% of patients are adherent to beta-blockers or statins after a year or two, according to a 2015 review article published in Open Heart.

Why would patients skip their medications, even after a life-threatening event? Doctors often attribute nonadherence to unintentional factors, such as forgetfulness or confusion, but surveys suggest that only about 30% of nonadherent behaviors fall into this camp, said medication adherence expert Marie T. Brown, MD, FACP, an associate professor at Rush Medical College and Rush University Medical Center in Chicago. “What is not commonly understood is that the vast majority of patients who do not take their medicines intentionally choose not to do so,” she said.

Tips to help with medication adherence include asking a patient in a nonjudgmental way what it's likTips to help with medication adherence include asking a patient in a nonjudgmental way what it's like to take multiple medications daily, allowing the patient to be honest with you, and spending time going over the risks and the benefits of the medicines.

That most nonadherent patients are willfully rejecting doctors' orders might seem shocking. “Past the surprise, as physicians, we have to accept that and then try to understand it, rather than say … ‘Well, look, I've done my job. I went through 12 years of training, and I'm giving you my best advice—take it or leave it. If you don't, it's on you.’ That is often the attitude of many physicians, young and old,” Dr. Brown said.

Meanwhile, innovators are exploring the potential of digital health tools in solving matters of adherence. From mobile apps to “smart” pill bottles to ingestible sensors, new digital health offerings are numerous, although some work better than others, experts say.

Read the full article in ACP Internist.

ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products, and activities of ACP.

Back to April 2017 Issue of IMpact