The Why's of Non-Adherence

• The person doesn’t like the way the medication makes them feel. Nausea, vomiting, dizziness, and appetite changes are common with many medications. These and other side effects may keep someone from taking their medications. In these cases, the prescriber and pharmacist can work together to identify alternatives with less troublesome side effects; or they can determine how to minimize or manage these effects. At the same time, it is important to find out if they have trouble swallowing pills or if they don’t like the taste of liquid medications.
• The person can’t afford the medication. People may be hesitant to admit they can’t afford their medications. It will be key to talk to them in an open, honest, and nonjudgmental manner. The prescriber and the pharmacist can work together to determine if there are lower cost generic options or medications that can be administered in less expensive formulations. When possible, it will help to use medications that are on the formulary of the person’s health insurance company. There also are a variety of discount initiatives, including pharmaceutical company assistance programs.
• The person and/or their caregiver has trouble administering the medication accurately. The prescriber and pharmacist can work to identify easier administration options, such as medications that can be taken once instead of three times daily or pills that don’t have to be cut.
• The person doesn’t think they need the medication. Sometimes when someone starts to feel better, they may think they no longer need their medication; or they may be in denial about their illness or the severity of their condition. The prescriber and pharmacist can take the lead on educating these individuals and making sure they understand the need to take all of their medication as instructed. This may involve multiple conversations and written information they can take with them. Both the individuals and their caregivers should be encouraged to ask questions and share any concerns they have.

Monthly or targeted medication regimen reviews by the pharmacist can help identify medication-related issues, including non-adherence. This presents an opportunity to identify and address reasons for non-adherence and get and keep the medication regimen back on track.

Even the best medication can’t be effective if the person doesn’t take it. Yet, non-adherence issues may fall through the cracks and go unrecognized until they cause a problem such as a fall or the need for an emergency department visit or hospitalization. Chad Worz, PharmD, BCGP, chief executive of the American Society of Consultant Pharmacists, stressed, “Compliance and adherence are the biggest challenges older adults face in their homes with their medications. With so many formulations, doses and medications that can be successfully used to improve someone’s quality of life, it comes with a complexity in terms of how many, how to administer (beyond time and swallowing) and what to expect … good and bad. Pharmacists are the only clinicians who can provide the ‘user’s guide’ to someone’s array of medications and should be engaged to help improve medication management.”