Behavioral Insights on Medication Adherence

Helping patients stick to their prescribed medications is essential for managing chronic conditions such as diabetes, hypertension, and cardiovascular disease. Poor adherence can lead to worse health outcomes, more hospital visits, and even higher mortality. Studies show that nearly half of chronic illness patients don’t follow their medication plans, contributing to an estimated $100-300 billion each year in avoidable healthcare costs across the U.S. [1].

The Complexity of Medication Adherence

Medication adherence extends beyond remembering to take medications. Social factors like financial challenges, limited education, low health literacy, and insufficient social support heavily influence adherence [2]. For patients with chronic conditions such as hypertension and diabetes, where regular medication is essential, these barriers often lead to poor disease control and increased risks of complications like stroke or kidney failure.

Behavioral Insights into Nonadherence

The field of behavioral science provides insight into why patients fail to stick to their prescribed regimens, with several key factors:

• Low Health Literacy – Patients with limited health knowledge may find it challenging to understand the value of staying consistent with their medications, which can lead to confusion and difficulties in properly managing their treatment. [3, 4].
• Illness Fatigue – Patients managing chronic diseases may experience physical and mental exhaustion from the constant demands of treatment and monitoring. This can decrease motivation and adherence as patients may feel overwhelmed by the continuous need to manage their condition. [4]
• Lack of Symptoms – For some chronic conditions, a lack of noticeable symptoms, especially early on, can lead patients to become complacent. This causes prioritizing of short-term comfort over the long-term benefits of staying on their medication [4]
• Lack of Provider Empathy – When patients don’t feel supported by their healthcare provider, they’re often reluctant to bring up medication issues, which can lead to lapses in adherence. Building trust encourages patients to talk openly about their treatment and stay engaged in their care. [4]

Evidence-Based Interventions

Many techniques have been proven to enhance medication adherence, especially when incorporated thoughtfully into clinical practice:
Simplified Medication Regimens: Consolidating doses can significantly improve adherence. A 2011 meta-analysis found that patients taking single-pill combinations of medications were more likely to adhere to their treatments than those taking multiple pills [5].

• Patient Education and Counseling: Research shows that personalized education and counseling can improve adherence, especially when patients receive regular follow-up consultations [6].
• Motivational Interviewing: Research indicates that motivational interviewing effectively improves medication adherence by helping patients address personal challenges and increases their willingness to make lasting changes [7].
• Mobile Health (mHealth) and Reminder Systems: Mobile tools such as reminders and progress tracking provide easy access to information, making it more straightforward for patients to stay consistent with their treatment plans. A recent meta-analysis suggests that mobile applications significantly improve medication compliance among adults with chronic diseases [8].
• Financial Incentives and Support: Financial assistance programs make prescriptions more accessible for patients with financial challenges, improving adherence, health outcomes, and reducing healthcare costs. [9].

The Role of Healthcare Providers in Adherence

Healthcare providers are critical in improving medication adherence in patients by addressing patient-specific barriers through approaches like motivational interviewing. One approach involves routine adherence assessments during consultations, where providers ask simple, non-judgmental questions like, “Have you noticed any side effects or other concerns with your medications?” or “Is there anything about your treatment plan that’s been difficult to follow?” These open-ended questions can help identify issues early, which allows providers to intervene before the isssue worsens.

Since adherence barriers vary from patient to patient, customized interventions are essential. For example, patients who have trouble remembering doses might benefit from text reminders or a combination pill that reduces the number of daily doses. Providers may enhance adherence by actively engaging patients in treatment decisions, using a shared decision-making approach. This collaborative style helps build a partnership that encourages patients to follow through with their prescribed therapies. It also allows for open discussions about alternatives, including options with fewer side effects or those that better fit the patient’s budget, ensuring that treatment is personalized to meet each patient’s specific needs and situation.

Working together with a team of healthcare professionals—such as pharmacists, dietitians, and behavioral health experts—can make a real difference in helping patients stick to their treatment plans. Pharmacists can simplify complex medication regimens by identifying duplicate prescriptions and preventing drug interactions. Dietitians can guide patients on diet choices that positively impact their health, while behavioral health specialists can support patients in overcoming mental and emotional barriers to adherence. This team-based approach gives patients well-rounded support, addressing both the medical and lifestyle factors that influence their ability to follow treatment plans [10].

Conclusion

Improving medication adherence is key to managing chronic diseases effectively. Behavioral science offers wisdom that can help providers identify adherence barriers and learn strategies such as regimen simplification, patient education, and digital reminders. Incorporating these approaches into patient care can enhance outcomes and support the goals of patient-centered care.

References

1. Neiman AB, Ruppar T, Ho M, et al. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities. MMWR Morb Mortal Wkly Rep 2017;66. DOI: Link
2. Wilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW, Portela M, Srivastava A, Li Y, McCarthy ML. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med. 2021 May;36(5):1359-1370. doi: 10.1007/s11606-020-06447-0. Epub 2021 Jan 29. PMID: 33515188; PMCID: PMC8131473. Link
3. Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Educ Couns. 2016 Jul;99(7):1079-1086. doi: 10.1016/j.pec.2016.01.020. Epub 2016 Feb 1. PMID: 26899632; PMCID: PMC4912447. Link
4. ​​Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics. 2021; 13(7):1100. Link
5. Sherrill B, Halpern M, Khan S, Zhang J, Panjabi S. Single-pill vs free-equivalent combination therapies for hypertension: a meta-analysis of health care costs and adherence. J Clin Hypertens (Greenwich). 2011 Dec;13(12):898-909. doi: 10.1111/j.1751-7176.2011.00550.x. Epub 2011 Nov 7. PMID: 22142349; PMCID: PMC8108883. Link
6. Aremu TO, Oluwole OE, Adeyinka KO, Schommer JC. Medication Adherence and Compliance: Recipe for Improving Patient Outcomes. Pharmacy (Basel). 2022 Aug 28;10(5):106. doi: 10.3390/pharmacy10050106. PMID: 36136839; PMCID: PMC9498383. Link
7. Bischof G, Bischof A, Rumpf HJ. Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice. Dtsch Arztebl Int. 2021 Feb 19;118(7):109-115. doi: 10.3238/arztebl.m2021.0014. PMID: 33835006; PMCID: PMC8200683. Link
8. Peng Y, Wang H, Fang Q, Xie L, Shu L, Sun W, Liu Q. Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis. J Manag Care Spec Pharm. 2020 Apr;26(4):550-561. doi: 10.18553/jmcp.2020.26.4.550. PMID: 32223596; PMCID: PMC10391210. Link
9. Rohatgi KW, Humble S, McQueen A, Hunleth JM, Chang SH, Herrick CJ, James AS. Medication Adherence and Characteristics of Patients Who Spend Less on Basic Needs to Afford Medications. J Am Board Fam Med. 2021 May-Jun;34(3):561-570. doi: 10.3122/jabfm.2021.03.200361. PMID: 34088816; PMCID: PMC8824724. Link
10. Esperat MC, Hust C, Song H, Garcia M, McMurry LJ. Interprofessional Collaborative Practice: Management of Chronic Disease and Mental Health Issues in Primary Care. Public Health Rep. 2023 May-Jun;138(1_suppl):29S-35S. doi: 10.1177/00333549231155469. PMID: 37226954; PMCID: PMC10226068. Link