To quote C. Everett Koop, M.D., the former U.S. Surgeon General, “Drugs don’t work in patients who don’t take them.” The high level of non-adherence in the U.S. today poses a major obstacle to achieving optimal health outcomes for patients and a significant challenge for the pharmaceutical industry as well as other involved stakeholder organizations. While it is clear that the industry does care about non-adherence and is spending money to address it, the sad fact is that this investment may at best be ineffective and might even be counterproductive.
Early attempts by the industry to tackle non-adherence have focused on patient education, prescription reminders and incentives. While these have had some short-term successes, they have done little to address the deeper issues of non-adherence. One reason is that people who sign up for a non-adherence program are more than likely reasonably adherent to begin with. These “hand raisers” are quite definitely not the major problem. The major problem lies with the “non-hand raisers” and the reasons why they do not initiate or why they quickly fall off medication regimens.
Generally speaking, about 20% of patients will consistently comply with a medication regimen if their physician asks them to and another 20% will remain stolid non-adherents no matter what steps are taken. It is extremely hard to move these two groups away from their core behavior. The other 60% of patients present an opportunity to really pursue individual causes of non-adherence and to find solutions that effectively change the…