Medication adherence - factors affecting adherence

Overview

Medication non-adherence arises from patient-related factors (health literacy, beliefs about medication necessity/concerns, psychological/cognitive factors), regimen-related factors (complexity, side effects, cost), and system-related factors (access, continuity of care) - identifying which category predominates for an individual patient directs the most effective improvement strategy
Common across chronic disease management generally, with non-adherence rates substantial even for conditions with clear evidence-based benefit from consistent treatment

The necessity-concerns framework captures a key psychological driver - patients weigh their perceived need for the medication against their concerns about it (side effects, dependency, "unnaturalness"), and a mismatch (low perceived necessity, high concern) predicts poor adherence independent of objective disease severity or regimen complexity

Structured, non-judgemental adherence assessment (rather than assuming adherence based on prescription refill patterns alone, which can be misleading) should be routine at review, particularly when clinical response is unexpectedly poor
Distinguishing intentional non-adherence (deliberate, belief/concern-driven) from unintentional non-adherence (forgetfulness, practical barriers) matters since the appropriate intervention differs substantially between the two

Addressing the specific identified barrier (education/reassurance for concern-driven non-adherence, practical aids like dose administration devices for unintentional non-adherence, cost-reduction strategies for financial barriers) rather than a generic "adherence counselling" approach applied uniformly
Non-adherence should be actively considered and explored before assuming treatment failure and escalating therapy intensity

Intentional vs unintentional non-adherence distinction, necessity-concerns framework, cost/access barriers, health literacy and adherence, polypharmacy complexity as an adherence barrier
Non-adherence should be routinely and non-judgementally explored whenever a patient's clinical response is unexpectedly poor, before assuming true treatment failure and escalating to a more intensive (and often more costly or higher-risk) regimen - this sequence avoids unnecessary treatment escalation when the actual problem is a addressable adherence barrier

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