Medication adherence helps to increase the chance of a successful treatment, avoiding clinical complications, and an economic burden for society.
The degree to which someone correctly follows a medical prescription regarding medication (as known as adherence) is a challenging factor especially in hypertension. It seems that half of people living with hypertension stop taking medications within the first year! This lack of adherence increases the risk of severe complications for most of the systems assisting in blood pressure control (e.g., coronary and cerebrovascular events). Therefore, adherence is important not only to control the primary condition, but also to avoid secondary disturbances. Lack of adherence also has consequences beyond the personal level, such as economic ones.
Initiation, implementation, and persistence are components of adherence. The first and the latter are not efficient in clinical practice, while implementation represents a patient attribute. The major two problems regarding drug adherence are characterized by non-persistence or good persistence with poor maintenance (i.e., implementation) of the dosing regimen (e.g., missed doses). Usually, side effects, difficulties with the practical aspects of taking medication, and necessity concerns are some of the main factors influencing the level of adherence. Lack of adherence is caused when new medications are started, however, patients cannot afford the medication leading to suboptimal daily implementation of the prescribed regimen. In turn, these factors may lead to treatment failure, disease progression, and the requirement of more complex treatments.
Both personal and economic factors have an elevated burden when medication is not being taking properly. Economic costs can rise due to the clinical complications regarding non-adherence since they are associated with poor health outcomes, increased service utilization, and health care costs. For example, “it is possible that about 8% of the global total health expenditure, could be avoided from adherence to medicine […] a total saving of €332 million could be achieved [in Europe] by increasing adherence to antihypertensive therapy to 70%.” There are different strategies to measure adherence. Electronic monitoring (i.e., an automatic compilation of drug dosing history) and drug measurement (i.e., monitoring of drug levels by blood or urine drug measurements) are the most accurate systems available.
The simplification of treatment is considered the gold standard to enhance adherence. This means a single pill fixed dose combination helps patients maintain a pharmacological treatment, and consequently, will allow control the primary outcome (e.g., hypertension) avoiding secondary disturbances (e.g., cerebrovascular events). Other strategies are based on patients’ awareness (e.g., education, motivation) and packaging (e.g.: [i] top-opening to provide easy access to medication, [ii] a reminder inside the box to reduce the risk of missing pills, [iii] instant weekday visibility, [iv] digital patient product information available via a QR-code which provides access to relevant information in an easy to read, legible format).
Adherence may have a significant impact on a subject’s health, as well as in an economic sphere. Therefore, strategies addressed to improve adherence should mostly be based on patient-tailored and measurement-guided interventions.
Written By: Vagner Raso