The importance of medication adherence

Taking your medicine exactly as prescribed is vital not only to manage an illness, but to prevent complications, and the development of resistance and new drug-resistant strains. 

Following your health professional’s directions in taking medication is essential if you hope to recover from an illness, or stay in remission from a chronic condition such as asthma, hypertension, diabetes and HIV/Aids, or a mental health condition such as depression.

Unless you take steps to remember to drink your medication, and at the times and in the manner (with food or not) advised, you can develop complications, and end up in hospital or worse – in the case of HIV/Aids, you can continue infecting other people. 

Looking at the global figures around medication adherence

Yet, according to a report of the World Health Organisation (WHO) Africa, 50-70% of patients globally don’t take medication as prescribed. (Among those who take it for mental health problems, the rate is 24-90%, notes Johns Hopkins Medicine.) 

The US Food and Drug Administration estimates that internationally, 20-30% of new prescriptions are not even filled at the pharmacy. According to the American Association of Diabetes Educators, about 30% of people with diabetes report missing at least one dose of medication a month; and a recent study across sub-Saharan Africa indicated that 40% of patients living with HIV/Aids either stopped their life-saving antiretroviral treatment (ART), or stopped going for follow-up consultations. 

In South Africa, which has the largest HIV/Aids treatment programme in the world, WHO Africa notes that ART has been expanded significantly, and policies introduced for earlier initiation of treatment.

But, that can only be effective if people take their ARVs as prescribed. So, why don’t they?

Why do people not adhere to their medication guidelines?

In a Masters of Pharmacy (Pharmacology) thesis at the University of Limpopo, MB Mathevula examined factors affecting adherence to treatment in patients on chronic medication at Mokopane Hospital. ‘Adherence’ was defined as ensuring medication was taken at the right time, in the right doses and in the right way.

Mathevula found that when a patient understood a specific regimen, “including the reasons for taking each medication and the intricacies of dosing schedules”, it could have a “profound influence” on adherence. 

Younger patients (aged 21- 40) were found “less likely to have forgotten to take their treatment” than older patients (41-87 years), more than a third of whom forgot to take medication in the month before the study.

Adherence was attributed to “faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition”. Non-adherence was seen as “an active decision, partly based on misunderstandings of the condition” and disapproval of medication taken not to cure a condition, but to “facilitate daily life or minimise adverse effects”.

A number of those who missed at least one dose did so because they weren’t at home, “which shows the reluctance to take medication with them” – a sign that they do not want other people to know they are taking treatment, reports Mathevula. 

Apart from stigma, problems in adherence included communication difficulties from language and cultural differences and heavy workloads at health facilities leading to short consultation times. 

The US FDA also notes as barriers to adherence the fact that some treatment regimes require multiple drugs taken at different times, which can be difficult to remember (here, the development and introduction of combination formulations can help); the way side effects of some medications can make people feel worse rather than better; and the fact that people may not feel the need to keep taking their medications once they start to feel better.

Tips to help you adhere to your medication schedule and guidelines

• Make a habit of taking medication at the same time/s each day, linked to a routine like brushing your teeth, or before or after certain meals (check if your medication needs to be taken on a full or empty stomach).
• Keep a calendar with your pills, and note the time you take each dose.
• Use a pill container with sections marked in days, and be sure to fill it at the same time each week (like Sunday night before bed).
• If you travel, carry enough of your medication for a few extra days in case you are delayed, and keep your medication in your carry-on bag.
• Take care you never run out: Clicks’ Repeat Prescription Service sends an SMS reminder for customers to renew their prescription and collect it at the pharmacy of their choice.

IMAGE CREDIT: 123rf.com