Background and Issues Associated with Medication Adherence

Adherence is defined as “the extent to which a patient’s behavior is consistent with health care recommendations” (Dunbar-Jacobs 2001). 

The term compliance also refers to the extent to which patients follow health care provider instructions.  Since the term noncompliance frequently has a negative connotation (Morisky 1986), it has been largely replaced by the term nonadherence.  Nonadherence to medication regimens can be detrimental to patient recovery and often leads to adverse complications, including inadequate treatment and hospital admission from 5% to 40% of the time (Haynes 2004, Dunbar- Jacob 2001). 

An estimated 11% of all hospital admissions are due to medication complications (Dunbar-Jacob 2001).  Inadequate patient medication education is a common reason for nonadherent behaviors and is an independent risk factor for unplanned 30-day hospital readmission (Haynes 2004, Marcantonio 1999). 

The overall cost of medication nonadherence to the U.S. health care economy is estimated to be greater than $100 billion yearly (Dunbar-Jacob 2001).   

Although medication education is a critical element and required step in the hospital discharge process (Martens 1998, Joint Commission on Accreditation of Hospital Organizations [JCAHO] 2004), ensuring that patients know how to take their medications properly and understand the importance of adhering to medication regimens remain the most problematic aspects of the discharge planning process. U.S. and Canadian studies have documented inconsistencies in the medication education component of hospital discharge resulting in poor patient knowledge of their medications (Alibhai 1999, King 1998, Cortis 1996). 

National and international accreditation organizations have identified the importance of medication education for enhancing patient safety efforts. The 2004 JCAHO standards (PC.6.10) require that “the patient receive education and training specific to the patient’s needs and as appropriate to the care and services provided.” Further, the London National Health Service advocates enhanced medication education support in the hospital setting (Department of Health 2000). Recommendations have also been made to individual hospitals to evaluate their discharge planning protocols to ensure patient safety and adherence with the medication education discharge process (Feingold 2001). While providing medication counseling at the time of discharge has been shown to be effective in increasing patient knowledge and adherence, it is not an ideal model as the day of discharge may be stressful and rushed, and often includes a plethora of other information and instructions.