Non-Adherence to Medications: The Silent Barrier to Effective Treatment

1. Primary Non-Adherence (Non-Fulfillment Adherence): Primary non-adherence occurs when a healthcare provider prescribes medication, but the patient never fills or initiates the treatment. This means the prescribed drug is never obtained from the pharmacy by the patient, resulting in a complete lack of treatment.² Common reasons for primary non-adherence include financial constraints of patients that make medications unaffordable, lack of understanding about the importance of prescribed medication, concerns about side effects or dependency leading to hesitation in starting treatment and poor communication between the patient and healthcare provider, resulting in uncertainty or doubts about the medication.

 
2. Non-Persistence: This type of non-adherence happens when a patient starts taking the medication but stops it prematurely without medical advice. Unlike intentional non-adherence, non-persistence is often due to miscommunication between the patient and the healthcare provider rather than a deliberate decision.² Common reasons include lack of proper follow-up with the healthcare provider, the patient mistakenly believing that the treatment is no longer needed, difficulty in managing side effects and adverse reactions without guidance and lack of expected benefit from the medication.
 
3. Unintentional non-adherence: It occurs when barriers prevent patients from following their treatment plan, despite their willingness to do so. That means, this type of non-adherence is not a conscious decision but rather happens due to external factors that interfere with the patient’s ability to adhere to the prescribed regimen.² Some of the common causes are access issues like difficulty in obtaining prescriptions and high medication costs, forgetting to take medication on time which can be due to busy schedules. complex medication regimens such as multiple drugs that are difficult to follow, cognitive impairments like memory problems in elderly patients and improper medication use like poor inhaler technique, difficulty swallowing pills often due to a lack of knowledge on how to properly use the medications.³
 
I4. Intentional Non-Adherence: Intentional non-adherence refers to a process in which the patient actively chooses not to follow the prescribed treatment or recommendations. This decision often reflects a rational thought process, where the patient weighs the potential benefits and risks of the treatment. Common reasons include fear of side effects or adverse drug reactions, concerns about long-term drug dependency, doubts about the effectiveness of the medication, social stigma especially in case of mental health medications, masking of other diseases and preference for alternative treatments.³
 
5. Non-Conforming Adherence: Non-conforming adherence includes any deviation from the prescribed medication regimen which means the patient is not taking the medication as directed.² Some of the examples includes skipping doses intentionally or accidentally, administration of medicines at incorrect times like taking a once-daily drug twice a day or taking a medication meant to be taken before food after meals, taking an incorrect dose and overuse of medication, such as taking more than prescribed in an attempt to feel better sooner.
 

Conclusion: