People tend to have trouble sticking with important prescription medications. This is no small matter. It’s been estimated that medication non-adherence (the formal name for this problem) is the source of $290 billion in “otherwise avoidable medical spending” per year in the US, due to complications of chronic disease that could have been avoided.
Why is it so hard for people to stick with their hypertension, high cholesterol, or diabetes medications? Why is it even a problem for many people taking meds to prevent a cancer recurrence, or rejection of a transplanted organ?
Traditional dogma has focused on simple forgetfulness and drug cost as key reasons (“Oops! I forgot to take my medication!” and “I can’t afford the $30 co-pay.”) And, while these are certainly factors for some people, they don’t explain the non-adherence problem fully. They don’t explain why non-adherence is also a major challenge in European countries that cover all drug costs. They don’t explain why trials of reminders and free medication have not “solved” the problem.
The oversight here is human psychology. It’s hard to stick with a medication (or any other healthy behavior) whose benefits are years in the future. It’s especially hard when the immediate or short-term annoyances inherent in taking a medication—trips to the doctor or pharmacy, the $30-copay, transient side effects—trump those long-term benefits. But that’s human nature. It’s the same reason a large portion of the population struggles to put enough away for retirement.
Up-front annoyances related to taking a medication are also often attitudinal in nature, a hurdle potentially larger than the concrete annoyance of a copay or trip to the pharmacy.
Consider the following results of a consumer survey of over one thousand adults on a medication for a chronic condition. Compared to taking a daily medication:
- 47% of respondents would rather take out the trash
- 45% would rather do the laundry
- 27% would rather get a shot
- 10% would rather get a cavity filled
The survey also revealed that younger adults—ages 18-34—and women had greater difficulties sticking with their medication. Fifty-six percent of younger adults admitted to either quitting a medication altogether or never filling even the initial prescription (compared to 16% of seniors aged 65 or older). This is likely explained by the same short-term vs. long-term quandary. Older people are closer to the longer-term effects of their chronic condition.
As for women, 32% admitted to the same—quitting a med or never filling—compared to 20% of men. And surprisingly, among women, 20% said they were more likely to persist with a prescription for their pet than for themselves. Perhaps that’s taking the selfless caregiver role a bit too far.
How does taking medication make people feel? Of the respondents in this survey:
- 25% said “It makes me feel old”
- 21% said “It makes me feel worried”
- 14% said “It makes me feel frustrated or annoyed”
Given the negative psychological overlay inherent in taking a medication for so many people, effective solutions to the problem will need to go beyond simple reminders and cost reductions. Effective solutions will need to turn the act of taking a medication into a more positive experience, so that patients actually see their medication in a different light.