Medicines non-adherence is endemic in the UK. Ask any pharmacist and they’ll be able to regale you with countless stories about patients who, one way or another, didn’t manage to comply with their medicines regime. Given the sheer scale of the problem, it’s little wonder that the government estimates £500 million could be saved by getting patients to take their medicines as prescribed. Not only do missing doses fail to relieve the patient’s symptoms, but they also lead to wastage at a time when NHS funds are all too precious.

To tackle the problem, it is vital to understand the motivation behind it. But, as Alison Carr – epidemiologist and clinical director at market research company Hamell – explains, the reasons behind non-adherence are often misunderstood. She gives five key points to bear in mind when counselling patients.
 

1. Patients don’t just forget to take their medicines...

It is often assumed that, despite the best intentions, many patients fail to adhere to their medicines regime simply because they forget to take the right tablet at the right time. But, Dr Carr explains, several studies carried out by Hamell show that only around 7 per cent of patients miss doses for this reason. “So there’s clearly a lot more going on,” she says.
 

2....in fact, many patients are intentionally non-adherent

More often than not, patients have made a conscious decision not to take their medicines as prescribed, says Dr Carr. Data collated by Hamell shows that only 10 per cent of patients who do not adhere to their medicines do so accidentally, while 63 per cent do so on purpose. The remaining 27 per cent attribute their non-adherence to a combination of the two. Dr Carr says this seemingly illogical behaviour is typical of human nature. “How many people exercise for 20 minutes three times a week? How many of us don’t drink excessively?” she asks. “It’s not about knowing the information – there’s something else going on.”
 

3. It’s all personal

The reasons behind medicines non-adherence are “complex” and individual to that particular patient, says Dr Carr. She explains people will often assess their decisions about prescribed medicines against the backdrop of their lives, beliefs, hopes, fears and the opinions of their friends and family. For this reason, they feel they are making “very logical, very reasoned decisions to use their medicines in particular ways”.
 

4. Complicated medicines regimes are rarely the cause

Dr Carr admits there’s an “element of truth” to the idea that patients are non-adherent because they can’t fit a complicated medicines regime around their lives. But patients will even be non-adherent when taking medication that is simple to administer, she says. One US study into non-adherence in multiple-sclerosis patients by an outpatient centre this year found that, while the majority reported it was easier to take their treatment in an injectable form, they were more likely to be adherent to their medicines regime when taking traditional tablets. “We make these assumptions and they’re not always founded,” Dr Carr stresses.
 

5. Understanding human nature can help

Changing the way you treat non-adherent patients could yield better results, Dr Carr suggests. Asking them whether they have taken their medication is a question already loaded with judgement, she says, and is unlikely to help matters much. Instead, it’s vitally important to instil a sense of confidence in patients, which will make them more likely to take their medication correctly. Ultimately, the patient should leave the consultation feeling that the importance of taking their medication outweighs any concerns they might have about taking it. 

Alison Carr spoke at law firm Matthew Arnold and Baldwin’s PING event in Watford on July 9