Medication non-adherence interventions should be based on personal systems approach

For medications to be effective, they must be taken in the correct dosage at the right time, as prescribed by healthcare providers. The World Health Organization estimates that half of patients take their medications incorrectly, costing the U.S. health care system and consumers about $300 billion each year. In a new article, University of Missouri researchers say medication non-adherence interventions should be based on a personal systems approach that focuses on integrating medication taking into daily routines and involving supportive people who encourage taking medications correctly.

Cynthia Russell, associate professor of nursing, and Todd Ruppar, assistant professor in the Sinclair School of Nursing, say educating patients about the dangers and potential costs of taking medications improperly is not enough to change their behavior. Rather, Russell and Ruppar recommend taking a personal systems approach that involves assessing individuals' daily routines, proposing ways to make medication regimens easier, tracking adherence and evaluating whether the individual took the medications correctly.

"Previously, the focus has been on the personal characteristics of the patient such as knowledge about how the medication works, motivation to take it, depression and other cognitive barriers," Russell said. "Instead, we need to give patients practical ways to adhere to their medication regimens, like putting pills next to the coffee maker as a reminder to take them each morning or using technology like cell phones or computers to set reminders to take medications."

Russell and Ruppar say there are high costs associated with non-adherence, including hospitalizations, surgeries and wasted medications. If people took their medications as prescribed, they would likely save money and prevent additional health problems.

"Patients often go back to their health care providers saying their health has not improved, so they assume that their medication isn't working," Ruppar said. "Prescribers usually start with one drug, then recommend a combination of medications. However, if patients took them correctly they likely wouldn't need the additional drugs."

The researchers are also studying how electronic medication adherence monitoring influences patients' behaviors. Patients are given pill caps embedded with computer chips that record how many times they take their medications each day. The caps also provide feedback over a period of time that allows patients and their health care providers to see how many doses were missed and whether the medications were taken during a prescribed window of time.