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Medication Adherence

Kunal Kishore Dhawan is the co-founder and CEO of Navia Life Care – a health technology company with a focus on patient care. Through their mobile application – Navia, and the associated doctor’s portal the company aims to revolutionize the way patients manage their treatments, with real-time monitoring by their prescribing doctors. In the past, he has worked in strategy and business development for a global pharmaceutical company – Fresenius Kabi, as well as had stints with PwC, GlaxoSmithKline, Ranbaxy and Abbott Vascular.


Neglecting the medication schedule is not a good practice. Author tells you how, on the contrary, it may increase expenditure on healthcare.


Adherence has been defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result.” The WHO defines ‘adherence to long-term therapy’ as “the extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds.” This definition implies that the patient has a choice and that both patients and providers mutually establish treatment objectives and the medical regimen and its successful completion.

Patient and caregiver perceptions (rather than providers’) regarding the efficiency of medical treatments are most relevant to adherence. Higher levels of perceived benefits as rated by patients and caregivers have been associated with better adherence to regimens for asthma and diabetes (Bobrow et al., 1985; Bond et al., 1992; McCaul et al., 1987; Radius et al., 1978).

Medication adherence occurs when a patient takes his/her medications according to the prescribed dosage, time, frequency, and direction given by professionals. The value of drug adherence can be seen in the unnecessary costs that are often incurred, and the opportunities to advance public health that are lost, when medicines are not taken for their full prescribed course. While much money has been spent on patient care, the desired outcomes are not always achieved; one major reason for this is poor drug adherence.

Problem of Non Adherence

A breakdown in the scheduled dosage, frequency and combination has the potential to result in unanticipated side effects and complications. Medication adherence presents a particularly complex issue for the elderly patients also. The relationship between adherence and age depends on various issues. It is always not intentional as in the case of adult patients. Among older adults, the consequences of non-adherence to medication may be more serious, less easily detected, and less easily resolved than in younger age groups. In some of the cases, an elderly patient could forget that he or she had already taken the prescribed amount of medication and unintentionally takes an over dose.

Medication adherence is a mounting worry to clinicians, healthcare systems, and other concerned categories because of increasing evidence that non-adherence is prevalent and associated with adverse outcomes and higher costs of care. Medication non-compliance is a gigantic issue in public health, because not taking medication means that people do not maintain health, they risk their health with more serious troubles, and they complicate the conditions that their medication is meant to treat. It seems quite simple to take medicines on time but is quite complex in application. A research published in Circulation: Cardiovascular Quality and Outcomes, offered insight into the problem of medication non-adherence. According to this, “four out of ten people would be willing to accept some degree of risk of immediate death rather than having to take a daily pill to prevent cardiovascular disease (CVD), and almost one in ten people would be prepared to sacrifice two years of life to avoid a daily pill.”

Non-adherence to medication regimens may result in an increased exercise of medical resources, such as physician visits, laboratory tests, unnecessary additional treatments, emergency department appointments, and hospital or nursing home admissions. Non-adherence may also result in treatment failure. Moreover, adherence failure can also affect the quality of life for patients and their families as well as the whole environment. Non-adherence of medication has, in turn, reached “epidemic” standards, as per some statistics:

• Half of all patients do not take their medication as prescribed and more than 1 in 5 new prescriptions go unfilled. In fact, identification and researching adherence is itself a serious and high effort task

• At least 125,000 Americans die annually due to poor medication adherence
• It is estimated that non-adherence costs the US health care system $100 billion per year (Vermiere et al., 2001). In one study, one-third of older persons admitted to the hospital had a history of non-adherence
• Nearly one-fourth of nursing home admittances may be due to older persons’ inability to self-administer medication

• Problems with medication adherence were cited as a contributing factor in more than 20% of cases of preventable adverse drug events among older persons in the ambulatory setting

• As adherence declines, emergency room visits increase by 17% and hospital stays rise by 10% among patients with diabetes, asthma, or gastric acid disorder

• Poor medication adherence results in 33% to 69% of medication-related hospital admissions in the United States, at a cost of roughly $100 billion per year

• New England Healthcare Institute estimates that the total potential savings from adherence and related disease management could be $290 billion annually — 13% of the annual expenditure on health

Factors affecting Non adherence

The issue of non-adherence can be led by various factors, like personal, economic, environmental, or even psychological.

• Firstly, Intentional non-adherence; where a patient does it intentionally; he/she willingly escapes from the prescribed schedule, or makes a modification in time and changes the combination of drugs.

o Poor financial condition
o Lack of resources
o Mind set of people (interest, priorities)

• A patient may have practical problems and the non-adherence, therein, can be referred to as unintentional non-adherence:

o The environment in which people live dominates the application of regimen

o Healthcare providers’ practice affects too, i.e. how healthcare systems deliver care and treatment, matters

o Peoples’ knowledge and beliefs about their illness plays a crucial role in completion of the treatment

o Their motivation and determination to manage it

o Patients’ expectations regarding the outcome of treatment and the consequences of poor adherence

How to cope with non-adherence:

• Educating patients on the medicines to increase their knowledge

• Simplifying the regimen and welcome related questions

• Making the medicine usage easier to remember (physical aids and reminders and apps)

• Improve communication between healthcare professionals

• Follow a patient- centered approach

• Identification of specific barriers for each patient

• Make it easier for patients to report non adherence

• Use of effective compliance aids

• New medicine service and facilities

We are connecting multiple stakeholders to increase adherence to treatment among patients. Our mobile app offering is a personal treatment manager, which acts not only as a medicine reminder, but also as an adherence tracking system for patients. Designed for patients, this app not only helps them take their medicines on time, but also keeps track of their treatments, and their progress in the same. Connected to this, on the backend, is a dedicated dashboard for medical professionals – whether they are in hospitals, clinics or running their own practice. The dashboard allows them real-time access to their patients’ adherence records, medicine history etc. We are also providing compliance solutions to hospitals and pharmaceutical companies through which they can increase patient adherence, and thus increase drug sales (for pharmaceutical companies) and improve patient engagement.

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