Medication adherence has long been a problem, with the widely reported World Health Organization (WHO) figure noting that as much as 50% of medications for chronic conditions are not taken as prescribed. The cost of non-adherence is significant, in terms of avoidable deaths, financial cost to the healthcare system, and potential lost revenue to Pharma and Medtech providers.
Can we address the issue? If you don’t take your medication, it’s not going to work – it’s that simple! But adherence isn’t simple, the factors affecting medication adherence are complex, and go beyond a lack of information, forgetfulness, or even access to medication itself. Understanding the complexity of non-adherence is key to addressing the issue. Sporadic efforts or over simplifying, as were symptomatic of efforts in the recent past … are not going to work!
Defining Adherence
Adherence is much more than simply the behavior of taking medication as prescribed. It encompasses many more behaviors such as attending clinical appointments, maintaining physical exercise and a healthy diet, making healthier lifestyle changes. This is additional to practicalities specific to medication adherence which include initiating the prescription, actual dosing in relation to the prescription, filling the prescription at the pharmacy, and persisting with the treatment.
WHO defines adherence as ‘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 provider’. Due to the wide array of behaviors related to adherence, it’s useful to conceptualize adherence as a continuum reflecting the extent to which any particular treatment recommendation is adopted by the patient.
Non-Adherence, is it intentional? Non-adherence can be categorized by two types; intentional and unintentional. Unintentional relates to barriers beyond a patients’ control which prevent them from behaving as recommended, such as financial barriers, lack of information or understanding, forgetfulness, ability. Intentional non-adherence relates to the patient's beliefs, perceptions and motivations, where a patient is reluctant to adhere due to concerns, worries, or fears.
Providing information alone doesn’t drive adherence (learn why, here).
To address the issue, research has now moved onto behavioral approaches and evidence based models that focus on patient's beliefs, motivation and planning abilities as the core explanatory variables. The Perceptions and Practicalities Approach (PAPA™) is a therapy specific model to developing effective patient-centered solutions. PAPA™ conceptualizes non-adherence as a complex behavior, looking at both the practicalities of medication adherence as well as addressing beliefs about medications that are associated with Non-Adherence. (Learn more about PAPA™)
The COM-B framework provides a systematic approach to understanding all behavior change interventions and how to apply the most effective techniques. It looks at what factors to select to address a patient’s capability, opportunity and motivation to effect positive behavior change.
Therapy and Medication Non-Adherence has a significant cost, both human and financial which can’t be ignored. With the advent of new digital tools, evidence based behavior change models and a greater understanding of the complex nature of adherence, effective patient support can address the long-standing issue of non-adherence.
Get the Pharma Exclusive Whitepaper: ‘Using Digital Behavior Change Interventions to Improve Therapy Adherence’
Request the full 20 page whitepaper which includes:
- How to apply Evidence Based Behavior Change models, specific to improvements in Therapy Adherence
- Why information alone doesn’t address adherence – the ‘information action gap’
- How Digital Behavior Change Interventions can be implemented into Patient Support Programs
- The 7 steps to designing Behavior Change Interventions
