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By U.S. Rao and Kenneth Pugh

U.S. Rao-finalKennth Pugh-finalPrescription medication non-adherence is a costly problem, which is evident from an estimated 125,000 avoidable annual deaths, unnecessary hospitalizations, and nursing home admissions in the United States. The terms “medication compliance” and “medication adherence” are used interchangeably. Conforming either to the requirements of the healthcare system for patient health or for the better quality of life of the patient will ameliorate this staggering healthcare burden.

The reasons for medication adherence failures are many. Interestingly, the pharmaceutical industry is focused on developing novel digital technologies to counter the medication adherence challenges. In this piece, we identify key factors contributing to the medication adherence failure and provide suggestions that could promote better medication adherence by the patient population.

Undoubtedly, the healthcare team recognizes the importance of medication adherence for better patient health. After diagnosis of a disease, physicians prescribe appropriate medications and advise patients to follow the dosing regimen while indicating possible tolerable drug side effects. Similarly, pharmacists dispense medications, counsel on the medications, and provide directions on medication compliance.

Despite the lack of drug side effects, about 50% of the patients do not comply with medication plans as prescribed. On the other hand, medication non-adherence is genuinely influenced by severity of the side effects and other factors. For example, the limitations on patients to visit physicians or pharmacists to consult on the adverse affects of their new prescriptions are clearly important factors contributing to medication non-adherence. The patient’s health insurance restrictions, payments required by patients to the physician for each visit, and patient-related psychological and behavioral factors are well recognized.

It’s also recognized that the admonishing language physicians and other healthcare workers use in advising on the importance of medication adherence and the constricted patient-physician consultation time due to the introduction of Affordable Care Act, which increased the patient population base and physicians’ workloads, all contribute the patient developing a distaste for drug therapy.

Thus, if patients aren’t proactive for self-health through medication adherence, the current healthcare burden will continue. While the research has repeatedly highlighted the applicable steps such as equipping patients with appropriate education on disease, drugs, and medication adherence, such efforts are yet to be proved effective.

Current research on several commonly used drugs for treating diabetes, hypertension, and hypercholesterolemia indicates that these drugs exhibit much more attractive beneficial effects for both healthy and patient populations. For instance, metformin is now established to exhibit anti-aging effects. Similarly, it is increasingly clear that statins exhibit anticancer prophylactic benefits against a large number of cancers and other syndromes such as vitiligo. These pleasant side effects are attractive to patients on metformin and statins who would want to be younger, do not want to be inflicted with cancer, or do not want to suffer psychologically for their visible skin discoloration.

Scientific literature is inundated with a large number of examples of medications with beneficial side effects that are clearly attractive to the patient population. Since the population is in general addicted to self-medicating with over-the-counter dietary supplements for better health, the scientific evidence for such opinions about these is yet to be established through rigorous scientific process. Thus, educating the patients about beneficial side effects of the prescribed pharmaceutical drugs could prompt them to adhere to medication instructions. Toward this end, an important requirement for patient education about drugs is that the physicians and pharmacists must keep abreast of current knowledge of drug repurposing and be able to confidently emphasize the additional health benefits of the prescribed drugs when counseling the patients.

U.S. Rao, Ph.D., is a professor and director of research at the Appalachian College of Pharmacy.
Kenneth Pugh is a third-year Pharm.D. student at Appalachian State University.