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Defining and understanding medication adherence

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Topics: AdherencePrimary CareTraining and Development

Definitions, evidence and the importance of effective consultations, with tools and interventions to facilitate medication adherence.

This article forms part of a series
  1. Defining and understanding medication adherence
    1. Explaining how to use or take medicines: supporting adherence
    2. Reminding to take medicines: supporting adherence
    3. Complex medication regimens: supporting adherence
    4. Swallowing difficulties: supporting adherence
    5. Manual dexterity: supporting adherence
    6. Visual impairment: supporting adherence
Contents
  1. Defining medication adherence
    1. Non-adherence
  2. Evidence for interventions
  3. Asking questions to identify barriers
    1. Capability
    2. Opportunity
    3. Motivation
  4. National and professional guidance

Defining medication adherence

Medication adherence can be defined as the extent to which a person’s behaviour corresponds with taking a medicine optimally. It is key to achieving therapeutic goals and improving patient outcomes. Whereas non-adherence leads to reduced clinical benefit and generates significant waste.  

Non-adherence

Non-adherence is further classified as: 

  • Intentional – where the patient decides not to follow the treatment recommendations based on their beliefs and preferences. 
  • Unintentional – where the patient wants to follow the treatment recommendations but faces practical barriers eg poor recall or forgetting to take medication regularly. 

Reasons for behaviours which drive low rates of medication adherence are complex and multifaceted. To impact significantly on medication adherence rates, patients need to be informed, motivated, and skilled (or supported) to take their medicines optimally. Patients may have different views from healthcare professionals about the balance of risks, benefits and side effects of medicines.

Evidence for interventions

Evidence supporting interventions aimed at improving medication adherence is inconclusive and suggests limited impact. Interventions with several components, tailored to the needs of each individual in their current social context often lead to more successful outcomes.

The National Institute for Health and Care Excellence (NICE) advises no single intervention can solve non-adherence and proposes a range of interventions, tailored to each individual be made available to promote medication adherence.

Asking questions to identify barriers

It is vital to have effective person-centred consultations to find out whether a patient is genuinely taking their medicines, or not, and gain an insight into why this is.

The CPPE learning programme on consultation skills for pharmacy practice: taking a patient-centred approach, offers general training on this.

Reasons for non-adherence can be due to barriers with capability, opportunity or motivation. The following example questions can help with understanding these barriers.

Capability

  • How easily can you read these labels?
  • How easily can you get your medicines out of this pack or blister?
  • How do you manage with using that inhaler – can you show me?
  • How many times in the last week did you forget to take a medicine?

Opportunity

  • What problems do you have getting your medicines on time?
  • Who helps you with your medicines?

Motivation

  • How do you feel about taking your medicine?
  • Can you tell me more about your worries?
  • What do you know about why you’ve been given the new medicine?
  • What matters most to you about your health?
  • How do you think medicines help?

National and professional guidance

NICE guidance on medicines adherence makes recommendations on how to support and involve people in making an informed choice about their medications.  

The Royal Pharmaceutical Society guidance on medicines adherence helps pharmacists to support patients to get involved in decision making regarding the medicines they take and improve adherence.   

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