Patient Adherence


By Dr. Dorothy L. Smith

Internationally recognized expert in patient communications, patient safety & patient compliance strategies for medications.


If Patients Only Knew


Patients would think twice if they only knew how dangerous it is to:

  • Stop a prescription drug prematurely
  • Stop a medication without telling their physician
  • Take half a dose in order to save money

Patients need to know that the cost of the medication is minuscule compared to the costs of treating the complications of patient nonadherence.

I have been writing on this subject for 30 years and am running out of filing cabinet space! Once health professionals, manufacturers and insurance companies realize that the patient “holds the power”, they will understand why so many treatment outcomes are not successful and why overall health care costs keep skyrocketing.

We need to recognize that the patient has to make decisions every day on how to manage their medications. For example, more than 95% of diabetes care is done by the patient. This is why adherence and patient decision-making are so important in the treatment of diabetes.

I believe that patients are making decisions to the best of their abilities and are trying to do the “right thing”. When they make a mistake, it is usually not their fault…they just didn’t receive the type of information they needed in order to make a wise decision at that particular moment.

One of the most effective methods of motivating patients to stay in treatment is to teach them how to recognize that their medication is “working”. Once patients are able to recognize their personal progress, they are more willing to stay in therapy.

Health professionals also have to change their approach and recognize patients as being experts for their own lives. This will require that they individualize the therapy and help patients create a treatment plan that works for both the patient and the health professionals.

Dorothy L. Smith, PharmD President and CEO Consumer Health Information Corporation
Cost of Nonadherence

The cost of patient nonadherence in health care reform

It doesn’t make any economic sense that overall direct and indirect health care costs due to patient noncompliance will cost U.S. taxpayers an estimated $700-800 Billion in 2010.

This is more than DOUBLE the cost ($300 Billion) to purchase all the prescription drugs for the United States.

It costs twice as much to treat patient noncompliance with medications than it does to purchase all the drugs.

Patients are facing tough decisions every day. . .


How would you answer some of these questions?

“How can I protect my prescription gel that should not be stored in a room over 77 degrees if my room is always warmer than that?”

“My transdermal patches won’t stick because I’m too sweaty. What can I do?”

“What do I do with my old medicines?”

“Can I still use my medicine if it expired a month ago?”

“Why does my pill look different this month than last month?””I just swallowed that little packet in my medicine container. Is this harmful?”

Patients Need a Game Plan for Hypertension

handwriting_000 40% of patients with hypertension are nonadherent 1-2

What is the patient’s point of view?

The patient’s point of view is often overlooked. Here are some of the reasons patients are giving:

Fear of Medications

“I was afraid of the medicine because I was told that once I started to take it I would have to take it all my life.” 2

Side Effects

“I don’t like them (medicines), they have lots of side effects, they can make you sick…I think that I might get worse instead of better” 2

Patient Education

“He [doctor] sends you away with a few words ‘here is your prescription’ and that’s it.” 2

It becomes very obvious why 40% of patients choose not to take their antihypertensive medications. Research also suggests that the level of cardiovascular risk can be related to the level of adherence.3

Put patients in charge of their game plan.

Patients need to be more involved in their health care. The only way to do this is to educate patients so they can be more active players. They need a game plan that will work for them.

There needs to be better communication between the doctor, pharmacist and the patient. The research is clear that handing the patient the same sheet of written medication instructions at every visit is a waste of money. Patients just throw it out. And doctors toss patient education materials if they are not time-saving and practical.

Patient-centered health care will increase patient adherence. Physicians and pharmacists are also more likely to spend time educating the patients when the disease gets severe. Ideas need to be given to providers so that they understand how to involve patients earlier in therapy.

The most effective patient information programs will be:
  • Evidence-based
  • Provide both the patient and doctor with counseling tools that meet the varying patient education needs at different stages of therapy
  • Written in a language the patient can understand

Don’t overlook the patient’s point of view. It is a critical factor that must be addressed before patient adherence can ever be improved.

Nonadherence Higher in Insulin Patients


Research shows that approximately 10% of all patients decide right in the physician’s office not to fill the initial prescription. It is striking that 26% of diabetic patients decide not to get their initial insulin prescriptions filled.

Why ?

Patients try to make wise decisions but often make critical decisions regarding their medications because of fears. Patients give the following reasons:

“I thought this was the result of personal failing” 5

Patients often believe it is their fault that they are being put on insulin.

“I’m afraid of needles, hypoglycemia, and weight gain”6-8

45% percent of patients would avoid injections if they were prescribed insulin. Close to 70% of patients would have a problem if they had to increase their injections to more than twice per day. 9

“I don’t believe that the treatment can help me” 9

Patients often fear that the disease is worsening and 73% of patients do not have faith in their treatment or medical team. 6,10

Address Patients’ Concerns

When you develop your patient information materials, make sure to address predictable patient concerns. For example, if 45% of patients are afraid of insulin injections, it will help decrease their fear of pain by explaining that, “Today, there are ultrafine needles that are almost painless.” 6,9

When a physician hands a prescription to a patient and automatically assumes the patient is going to follow through and get the prescription filled, they are making a big mistake. Patients do not normally tell the physician they are not going to get the prescription filled because they want to “please” the physician.

At the end of the day, it is the patient’s decision to take or not take the medication.

Patients weigh the risks against the benefits of a drug therapy whenever they are handed a prescription.

One of the reasons that so many initial prescriptions go unfilled is that patients are not told the risks of not filling a prescription.

Physicians and pharmacists are pressed for time in their clinical practices. They need effective patient information tools that they can use to help make this happen.

*References available upon request

REMS is Nothing New to Patients

REMS is a buzzword in pharmaceutical companies and FDA these days. However, REMS is not new to patients. They have been dealing with risk management for years.

Patients are very concerned about the risks vs. benefits of a medication. The reason is that they are the ones who will have to live with any consequences of the prescription drug therapy.

Right now, too many patients are dropping out of therapy because they are afraid and do not know how to manage side effects. What they need is practical and understandable risk management information that will help them maneuver a therapy safely and wisely.

Consumer Health Information Corporation

(703) 734-0650 (703) 734-1459

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