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non-compliance

Failure to comply with prescribed treatment/medications. Etiology: - low health literacy* is the most common cause of medical non-compliance [1] - more informed patient tend to have better compliance & better outcomes [2] - fear, disrespect & denial may be reasons of non-compliance [1] * low health literacy can interfere with ability of patients to understand treatment plans & result in poor health outcomes & ineffective use of health care resources [1] Epidemiology: - in general, compliance with long-term treatment is 40-60% Management: - The most effective approach for exploring medical nonadherence with a patient is to begin with nonjudgmental questions [6] Notes: - 31% of prescriptions are never filled [5] - older patients are more compliant with medications than younger patients [5] - some prescribed medications are unnecessary or even harmful; patients might have good reasons not to fill those prescriptions [5] - patients who receive free medications are 63% more likely to fill prescription [5] - change in pill color may be associated with non-compliance [4]

References

  1. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  2. Wu JY, Leung WY, Chang S, Lee B, Zee B, Tong PC, Chan JC. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ. 2006 Sep 9;333(7567):522. Epub 2006 Aug 17. PMID: 16916809
  3. Prescriber's Letter 14(8): 2007 Medication Adherence Toolbox General Information About Medication Adherence Detail-Document#: 230811 (subscription needed) http://www.prescribersletter.com
  4. Kesselheim AS et al. Variations in pill appearance of antiepileptic drugs and the risk of nonadherence. Arch Intern Med 2012 Dec 31 PMID: 23277164 http://archinte.jamanetwork.com/article.aspx?articleid=1487287
  5. Moloo J Understanding Primary Nonadherence to Prescribed Medications NEJM Journal Watch. May 1, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Tamblyn R et al. The incidence and determinants of primary nonadherence with prescribed medication in primary care: A cohort study. Ann Intern Med 2014 Apr 1; 160:441 PMID: 24687067 http://annals.org/article.aspx?articleid=1852865
  6. NEJM knowledge+ Question of the Week. Dec 20, 2022 https://knowledgeplus.nejm.org/question-of-week/820/ - Poulter NR et al. Medication adherence in hypertension. J Hypertens 2020 Apr; 38:579 PMID: 31834123 - Kini V, Ho PM. Interventions to improve medication adherence: a review. JAMA 2018 Dec 18; 320:2461 PMID: 30561486