Medication non adherence and its implications (I)

“Doctor, as for me I don’t like taking medicine oo”

Dzifa Dey

Medication adherence is defined by the World Health Organization as “the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider.

The treatment of chronic illnesses like autoimmune conditions commonly includes the long-term use of drugs. Although these medications are known to be effective in combating disease, their full benefits are often not achieved because about 30 to 60percent of patients do not take their medications as prescribed.

Successful management of chronic diseases, like lupus, involves a partnership based on a mutual understanding of specific treatment goals, which is the best way to minimize morbidity and improve clinical outcomes.

Why is Adherence Important?

Ward et al. showed that Lupus patients who participated more actively in their care had less organ damage over a median follow-up period of 4.7 years(1).

Nonadherence with medication regimens may result in increased use of medical resources, such as physician visits, laboratory tests, unnecessary additional treatments, emergency department visits, and hospital or nursing home admissions. Nonadherence may also result in treatment failure.

In one study, one-third of older persons admitted to the hospital had a history of nonadherence. Antibiotic resistance is mainly driven by non-adherence and non-compliance with treatment schedules.

Improving adherence with medication regimens can make a difference. A recently published study by Sokol et al found that for a number of chronic medical conditions – diabetes, hypertension, hypercholesterolemia, and congestive heart failure – higher rates of medication adherence were associated with lower rates of hospitalization , and a reduction in total medical costs

What Causes Non-Adherence to Treatment?

With the invention of “Doctor Google”, patients have a wide range of information about disease and treatments, though some of the information may be purely hogwash, some patients may be gullible and believe all that is on the internet. Bad news sells and so the negative reports of drug side effects is what patients tend to believe or are more likely to see. This makes them have reservation about taking treatments prescribed.

The African is an especially spiritual being and would prefer to seek spiritual or herbalist treatment over more orthodox medication believing most often erroneously that they don’t have any side effects.

Patient would happily come to see the doctor carrying samples of very expensive herbs, supplements and magnetic gadgets, to substitute for her regular orthodox medications which may cost far less and have been proven by science to work. But guess which they would prefer to spend money on?

Financial problems, fear of side effects, difficulty navigating the public health system and perceived treatment inefficacy as important barriers to adherence.


What Contributes To This Problem?

Doctors frequently underestimate the problem of nonadherence in their patients and so find it impossible to correct the problem. (2).

Factors contributing to poor medication intake are numerous and include those that are connected to patients (e.g., low  health knowledge and lack of involvement in the treatment decision–making process), those that are related to doctors (e.g., prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and provision of care by multiple physicians who recommend different treatments), and those that are related to health care systems (e.g., doctor consultation  time limitations, limited access to care, and lack of health information technology)(3).


  1. Chambers SA, Rahman A, Isenberg DA. Treatment adherence and clinical outcome in systemic lupus erythematosus. Rheumatology. 2007;46(6):895-8.
  2. Atreja A, Bellam N, Levy SR. Strategies to Enhance Patient Adherence: Making it Simple. Medscape General Medicine. 2005;7(1):4-.
  3. Brown MT, Bussell JK. Medication Adherence: WHO Cares? Mayo Clinic Proceedings. 2011;86(4):304-14.







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