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The Link Between Side Effects and Lack of Medication Adherence

Written by Sherin Benjamin PharmD’27
Published on April 20, 2022

A lack of medication adherence occurs when patients do not take their medicine as prescribed. This means that the patient completely stops taking their medication or takes it more or less than prescribed. Patients fail to realize that a lack of adherence can give rise to a worsening of their disease, premature death, or increased health care costs. Some of the common reasons for medication non-adherence tends to be something as simple as forgetfulness. Other major reasons are the patient’s inability to understand how their medication will help treat their disease, cost of medication, or worry of dependence. However, the presence of side effects in patients is an underlooked reason for non-adherence.

In a study presented at the American Academy of Physician Assistants Conference in 2017, 19% of patients undergoing pharmacotherapy for many types of diseases experienced unpleasant side effects. Of those who experienced unpleasant side effects, approximately ⅓ reported this as the reason for missing and skipping doses while the other ⅔ stopped taking their medication.  Less than half of the participants in the study reported that their prescriber never gave information about adverse effects and 20% said that they did not receive information about adverse effects from their practitioner, nurse, or pharmacist. A lack of medication adherence due to side effects does not discriminate by disease. In study of schizophrenic patients, 86% reported side effects and 43% of them reported that they do not adhere to their medication, showing the significant correlation between patients experiencing side effects and non-adherence. Another study of breast cancer patients showed that the severity of their side effects had a negative correlation to their adherence. The study emphasized that many women felt “unprepared for the side effects of hormone therapy.” Much of their side effects could have been treated through other means, like lifestyle or psychological interventions, but were not addressed as part of their treatment. Hypertensive patients perceive that their primary caregiver may have a negative attitude towards them and this was cited as one of the reasons for not adhering to a medication regimen.  Apparently, patients may be too afraid to discuss their concerns of side effects with their primary caregiver.

These alarming statistics make us question: how can the healthcare team address side effects and increase medication adherence? Many studies show that better communication between clinicians and patients improves adherence. When evaluating the connection between communication to medication adherence, it was found that distrust of their clinician was the primary reason for nonadherence and patients would rather trust their own research. Patients who persisted in asking all questions about their diagnosis, treatment, concerns, and side effects to their prescriber were often satisfied with their treatments because they were on the same page as their practitioner. In another study published by the American Heart Association, researchers found that in hypertensive patients, “the odds of poor medication adherence are greater when patient–provider interactions are low in patient centeredness and do not address patients’ sociodemographic circumstances or their medication regimen.” These studies show the clear link between communication of clinicians and medication adherence. 

Patient-centered care, where the practitioner and pharmacist foster greater communication, would give patients a positive atmosphere to express their concerns about their medications. Clinicians should aim to address side effects by encouraging discussion and following through with altered or alternative treatments. By resolving this communication gap, the side effects patients deal with would be talked about and treated, making this an effective way to increase medication adherence. 

Categories:  Philadelphia College of PharmacyPharmacy