In a perfect world, all patients would adhere to their treatment regimens.

But the world is far from perfect.

Definitions1

The extent to which the patient’s behavior matches the prescribers recommendations. The term “compliance” has been increasingly replaced by the term “adherence”.

The extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. “Adherence” evokes more the idea of cooperation between the prescriber and his patient and less the connotation of the patient’s passive obedience to the physician’s instructions.

The length of time between initiation and the last dose which immediately precedes discontinuation.

Adherence related sciences represent a complex and rich field because of the fact that it operates across the boundaries between many disciplines: medicine, pharmacy, nursing, behavioral science, sociology, health economics, IT&C, service design, communication, etc1. We will focus on adherence to treatment regimens.

Adherence is a process composed of initiation, implementation and discontinuation. Initiation occurs when the patient takes the first dose of a prescribed medication. Implementation is the extent to which a patient’s actual dosing corresponds to the prescribed dosing regimen, from initiation until the last dose. Finally, discontinuation occurs when the patient stops taking the prescribed medication, for whatever reason(s). As a consequence, non adherence happens in the following situations or combinations thereof: late or non-initiation of the prescribed treatment, sub-optimal implementation of the dosing regimen or early discontinuation of the treatment, known as non-persistence1.

Adherence is an issue for virtually all treatment regimens and all disease conditions. It affects all social classes and cultures. Non-adherence to medication is reported in all geographies, no matter the level of economic development.

Average rates to different treatment regimens2

0%
to medication
0%
to screening
0%
to exercise
0%
to medical appointment
0%
to diet


Average adherence rates of 10 selected disease conditions2

Sleep disorders 65%
Diabetes 67%
Pulmonary disease 69%
End-stage renal disease 70%
Cardiovascular 77%
Skin disorders 77%
Seizures/brain disorders 78%
Cancer 79%
Arthritis 81%
HIV 88%


Average adherence rates to hypertensive medication in 5 European regions/countries3


Austria: 66%


Wales: 62%


England: 59%


Poland: 42%


Hungary: 30%

Improving adherence will likely help create a win-win scenario among patients, professionals, payers and pharmaceutical companies.

Poor adherence to medication accounts for substantial worsening of disease, death and increased health care costs4.
It has serious negative consequences for patients, providers, sick funds, employers, pharma industry and society5.

Many studies demonstrated that poor adherence with a therapeutic regimen have a major impact on clinical outcomes and, as a consequence, on patients’ quality of life.

The impact of non adherence on costs

The impact of non adherence to medication on health-care resource utilization (HCRU) and therefore costs are likely to work in two ways:
– The immediate and direct impact of poor compliance on medication acquisition costs. Adherence will increase these costs.
– The less immediate and indirect impact of poor adherence on subsequent overall HCRU associated with the condition being treated, as a result of affecting clinical effectiveness, and thus health outcomes.

Non-adherence is likely to reduce medicine acquisition costs but increase subsequent overall HCRU. For people who continue to obtain prescriptions but stockpiling their medicines, the impact is keeping the same level of acquisition and increasing the indirect costs10.

Improved adherence to medication produces substantial medical savings11

Roebuck et al. studied the relationship between medication adherence and the use and cost of health services in patients who had one or more of the following four chronic vascular conditions: congestive heart failure, hypertension, diabetes, and dyslipidemia.

This study shows that adherent patients spent significantly less than nonadherent patients, after combining the increase due to Rx pharmacy refills (in green on the graph) with the medical costs due to hospitalizations or  emergency department visits (in purple on the graph).

Impact Of Medication Adherence In Chronic Vascular Disease On US Health Services Spending
(costs adherent vs. non adherent patients)

 

impact on costs for health care system and sick fund of a bad adherence

Annual per person savings due to adherence (in orange on the graph) amounted to $7,823 for congestive heart failure, $3,908 for hypertension, $3,757 for diabetes, and $1,259 for dyslipidemia.

References
Contact us
Loading...
  • "I'm feeling better when I'm not on treatment than when I am."

    Sorin, 46 yo, Crohn's disease patient

  • "The side-effects are worse than the disease. We shouldn’t ingest these toxic chemicals."

    Adina, 32 yo, allergic rhinitis patient

  • "If people would simply go vegan, go green, and do yoga, we would have no disease or need for pills in the first place."

    Anca, 32 yo, melanoma patient

  • "Doctors are all just pill-pushers out to make a quick buck of us"

    Dan, 68 yo, heart failure patient

  • "I don't feel any difference on medication.“

    Ela, 45 yo, hep B patient

  • "It's really, really difficult to deal with the side effects."

    Adelina, 52 yo, cancer patient

  • "I have such a messy life...that's why it's so difficult to stick to my medication schedule"

    Dinu, 34 yo, HIV patient

  • My doctor recently prescribed me a new drug. I'm so scared to try it 🙁 I'm so scared of side effects like the ones in the past!

    Alina, 26 yo, epilepsy patient

  • "I don't really understand how and when to take all these pills!"

    Ana, 76 yo, hypertension & dyslipidemia patient

  • "My GP prescribed me drugs for my diabetes. But I don't feel I'm ill...I just feel normal."

    Mihai, 43 yo, diabetes patient

  • "There is no way I could see myself being able to inject a drug deep into my skin!"

    Valentin, 42 yo, psoriasis patient

  • "I'm feeling I'm completely cured. Finally! A life without medicines!“

    Ema, 36 yo, asthma patient