Take as Directed: Some Stats and Facts Regarding Medication Adherence

Medication Adherence is the most important factor determining Medical Outcomes– WHO, 2003 - World Health Organization, Adherence to long term therapies: evidence for action.

Compliance Rates for “Life Saving” prescriptions is less than 50% - World Health Organization, Adherence to long term therapies: evidence for action, 2003.

22% of US Patients take less of their medications than prescribed. - CMAG Case Management Guidelines, CMSA.org.

5-20% of patients are using more than one medication, in error, from the same class - Singh R., “How a series of errors led to recurrent hypoglycemia,” Journal Of Family Practice, June 2006:Vol.55, No.6.


32 million Americans are taking three or more medications daily - CMAG Case Management Guidelines, CMSA.org.

29% of the patients stop taking their prescription medications before supplies run out or before they have completed a course of therapy - CMAG Case Management Guidelines, CMSA.org.

Approximately 125,000 deaths occur annually in the United States because of non-adherence with cardiovascular medications. - CMAG Case Management Guidelines, CMSA.org.

Only about 50% of any given patient population continues taking their medication. Of these remaining patients, about 22% take less of their medication than is prescribed. They miss or skip doses and consequently lose the maximum potential benefits of therapy. -CMAG Case Management Guidelines, CMSA.org.

"In the U.S., non-adherence affects Americans of all ages, both genders and is just as likely to involve higher-income, well-educated people as those at lower socioeconomic levels." - "Enhancing Prescription Medicine Adherence: A National Action Plan," National Council on Patient Information and Education, August 2007.

"Medication non-adherence is a problem that applies to all chronic disease states"- "Enhancing Prescription Medicine Adherence: A National Action Plan," National Council on Patient Information and Education, August 2007.


It's important to know these facts and statistics to completely understand how serious medication adherence can be. We as health care providers can have a direct impact on these statistics and increase adherence to prescription medications by spending time with the patient, carefully explaining the importance of the medication, adverse side effects and therapeutic results. We should also work to follow-up with patients to make sure that they are taking their medications as directed, that they are refilling their medications, and to identify any barriers that might exist that keep the patient from taking their medications (i.e. cost or forgetfulness).

If you are interested in reading the full version of the World Health Organization's Adherence to long term therapies: evidence for action; it can be purchased directly from WHO by clicking here.

To download the CMAG Case Management Guidelines from the Case Management Society of America, click here.

If you would like to read Enhancing Prescription Medication Adherence: A National Action Plan by the National Council on Patient Information and Education; you can download the PDF by clicking here.

Looking Within the System

Is is possible that the healthcare system itself can contribute to a lack of medication adherence? In a study of managed care organization enrollees for 3 years, individuals went without medications an average of 20.9% of the time. Findings from this study led to further research that found great variations in patient adherence among prescribing physicians. Although no explanation was offered, the findings suggested that there might be a link between patients’ adherence and the behaviors of health providers. This might be explained by a combination of a systems approach (emphasizes how the environment, including health care systems affect patients’ adherence) and the communications approach (this approach views improving provider-patient interaction and patients’ satisfaction as a way to improve adherence).

Here are some examples of Health Care Delivery Systems and Health Care Providers Can Affect Adherence:

• higher co-payment levels are associated with reduced compliance
• pharmacy-based programs, including patient education, medication dispensed using adherence aids such as custom-packaged blister packs, or regular follow-up with pharmacists can improve patient adherence
• good communication between patients and health providers
• higher patient satisfaction with their relationship with the physician will increase adherence

In a study of patient-physician interaction, two thirds of physicians did not even ask their patients any questions about barriers or side effects of their drug use! If physicians would spend a bit more time telling patients about their medications, adherence would most likely go up. There is a definite need to look within the health care system and see what works and what does not work to improve medication adherence nation-wide.

As nurses, we might be able to fill in this gap. If these findings are correct and if physicians are not meeting the educational needs of the patient, then as nurses, we can spend more time educating the patient on how to take their medications properly. We should not only see an increase in medication adherence, we might even seen an increase in patient satisfaction. Who knows, we might even be able to change the system!

See this article from the Journal of Managed Care Pharmacy to read detailed information about these studies!

Helpful Reminders for Taking Your Medications

It's easy to forget to take your medications and forgetfullness is one cause of the lack of medication adherence. Below are some tips for remembering to take medications. This came from an article regarding thyroid medication, but these helpful tips can be used in any situation and might prove to be helpful teaching tools for patients who have a hard time remembering to take their drugs regularly.

Helpful tips for remembering to take medications:

1. Write it in your datebook. Write it in a special color that is hard to miss.

2. Since you're reading this on a computer, consider putting your reminder in your computer's scheduling program. Some programs allow you to set a regular daily "appointment" at a particular time. Some even have an alarm function that you can set.

3.Put a message on your computer's screen saver.

4. Keep your pill container right on top of your alarm clock, so you can remember to take your medicine first thing in the morning. (But be careful to keep your medications away from children.)

5. Put a note wherever you'll notice it every day - on the refrigerator, on your coffee maker, on your toothbrush, on your bathroom vanity mirror, etc.

6. Take your medicine the same time every day, so it becomes a habit.

7. Hire a calling service to give you a daily "wakeup" call to remind you to take your pill. If you have a home voicemail system such as "AnswerCall," you can even program a daily reminder call at the same time each day. You can even sign up online for a free service, like "Mr Wakeup," which will make free reminder calls to you.

8. Use a pill sorter, or a device known as a "dosette," which has compartments for different days, or even different times of the day. See the picture at the top of this post for an example of a "dosette".

9. Get a special device to remind you to take your pill. Epill.com offers a variety of devices, including medication computers, vibrating watches, automatic dispensers, beeprs, and other alarms that can help keep you on schedule for taking your medication.

10. Enlist the aid of a family member or friend to help. Sometimes, just a few weeks of friendly reminders can help you get into the habit of taking your medicine at the right time every day.