reasons for patient non compliance with their medications

Patient non-compliance with medication is a problem that can have adverse effects on patient outcomes. Non-compliance with medication can occur in the in-patient or out-patient setting. Leigh (2010) estimates as many as 50% of all prescriptions filled—between one and 1.5 billion—per year are not taken correctly (p. 1). Moreover, there are different types of non-compliance, including taking medications incorrectly, taking the wrong dose or at the wrong frequency, or not taking the medications at all. The causes of patient non-compliance with medication can be traced to miscommunication, requiring healthcare leaders to take a more active role in patient advocacy and education. Misunderstandings of how a medication should be taken, what the medication is for, and other issues related to patient education can be directly solved via direct intervention and improved communication. However, some of the causes of patient non-compliance with medication are due to structural issues including the costs of medication and the fact that many medications are not vegetarian and therefore inappropriate for many patients.
Not understanding what the medication is for, how it needs to be administered, and in what dose means that patients are not receiving proper education. As Leigh (2010) points out, proper education about medications “reduces readmissions, emergency department visits and saves money,” (p. 1). DeBrincat (2012) adds that many patients have difficulties understanding the instructions they have been given, due to factors like language and cultural barriers, memory or cognitive impairments, or simply due to lack of information. Some non-compliance issues are unintentional, as with patients who simply misunderstand the instructions. These are problems that can and should be solved by developing more robust protocols for nurses and pharmacists regarding medication education.
Unintentional non-compliance with medication can be related either to cost or to patient ethics. The financial barriers to medication compliance are more difficult to overcome than medication education or communication. Rising costs of healthcare insurance and the rising costs of medications lead to many patients being unable to afford the medications they need (Weiner, 2001). Nurses in positions of leadership can play a more active role as patient advocates to press for a healthcare system driven less by profit and more by achieving patient outcomes. Hospitals may be able to work with pharmaceutical companies directly to develop medication relief programs for low-income individuals. When possible, pharmacists can recommend alternative medications or generic versions if doing so means the difference between patient compliance and non-compliance.
One of the reasons for intentional patient non-compliance with medication is related to religion, ethics, and other personal belief systems. Some patients may be dedicated to animal rights and the ethical treatment of animals, thereby eschewing meat products and any products that contain animal by-products including pharmaceuticals. Hoesli & Smith (2011) point out that several religions, including Hinduism, Judaism, and Islam, prohibit the consumption of swine and bovine products, but more than 1000 medications contain inactive ingredients derived from these sources,” (1). Pharmaceutical companies that can manufacture medications without using animal by-products can and should do so in order to increase patient compliance. Nurses and pharmacists who are aware of vegetarian medication options can recommend those to their patients in order to increase patient compliance.
Religious beliefs, cost, financial constraints, communication, and education barriers lead to patient non-compliance. Non-compliance should not be viewed as a patient problem but as a problem that originates in the healthcare system itself. The system can improve the way it manufactures and markets medications, and the way it communicates medication instructions to patients or their caregivers.




References

De Brincat, M. (2012). Medication adherence: patient education, communication, and behaviour. Journal of the Malta College of Pharmacy Practice 18(2002).
Hoesli, T.M. & Smith, K.M (2011). Effects of religious and personal beliefs on medication regimen design. Orthopedics 34(4): 292-295.
Leigh, E. (2010). Teaching patients about their medications. The Center for Healthcare Communication. Retrieved online: http://www.communicatingwithpatients.com/articles/teaching_about_meds.html
Weiner, S. (2001). I can’t afford that! Journal of General Internal Medicine 16(6): 412-418.