Does taking a pill with or without a meal have an impact on adherence? Does the number of times per day that a patient is required to take pills have an impact on adherence, from a patient’s perspective?The answers to these two questions are “It depends”, and “It depends. Numerous factors influence patient adherence to prescribed instructions for medication. Two physician/pharmacist behaviors can positively influence adherence, according to research.
Factors That Influence Patient Adherence to Medication Instructions
Numerous factors influence patient adherence to medication instructions. No single factor is responsible for a patient failing to take medication correctly, or at all. The most significant factors affecting adherence are listed here, with citations to the sources where information about them was found.
- Degree of literacy
- Cultural differences
- Presence of mental illness
- Pediatric or geriatric status
- Medication cost
- Access to a pharmacy
- Negative beliefs about medication
- Shift work, work restrictions
- Fear of side effect
- Lack of belief in benefit
- Fear of dependency
- Fear that medication is dangerous
- Lack of desire
Physician/Pharmacist Behaviors That Positively Influence Adherence
- The best advice seems to be that clinicians should identify the patient’s challenge to taking medication correctly, and then work with the patient to overcome it. “This will ideally result in better medication adherence and stronger overall patient wellness.”
- Tailoring “solutions to specific patient needs and challenges” results in better adherence to prescribed medication instructions.
- Simply ordering patients to take their medications or giving patients arbitrary instructions does not increase adherence, and “will not eradicate patient barriers.”
- However, if providers use effective communication skills to ask patients to tell them what keeps patients from taking their medications, then providers can develop strategies to overcome the barriers discovered through these conversations.
- Adherence solutions must be tailored to the nonadherence problems. “In the asymptomatic patient, for example, understanding the patient’s perspective is vital. Empathetic comments, such as ‘It is difficult to take a medicine when you don’t feel any different whether you take it or not'” will help. The provider can build a trusting relationship through empathy and let the discussion continue.
- Encouraging patients to “develop a consistent medication management routine without using technology” improves adherence. A provider can ask, “Do you take your medication with breakfast?” If so, then the patient should be asked to “follow that pattern and keep her pills where … she [will eat] her meal.”
- An analysis of over 700 studies on the topic of patient adherence examined a wide variety of strategies to improve adherence, “including special packaging, individualized instructions, consequences/rewards systems, and reminder devices.” The findings indicated that “the only somewhat consistently effective approach was habit analysis, and linking medication adherence with existing habits.” This means, according to the author, “that if I’m prescribing a pill that’s to be taken twice a day, I ask the patient, ‘Can you think of anything that you always do twice a day?’ and if the patient says ‘Yeah, I brush my teeth,’ then I say, ‘Okay, then take this pill every time you brush your teeth. Put the bottle with the toothpaste.'”
- One author concluded, “There is no single intervention, strategy or bundle of strategies that will be effective with all patients; interventions must be tailored to each person and each situation.
Once-Daily Prescriptions Are More Likely to Be Adhered To Than Multiple-Doses Daily
- According to research, “the average adherence rate (the degree to which patients correctly follow prescription instructions) for medicines taken only once daily is nearly 80 percent, compared to about 50 percent for treatments that must be taken 4 times a day.”
- Thus, it makes sense that a patient’s medication regimen should be made as simple as possible. Complex regimens are one of the reasons for non-adherence. Physicians should prescribe medications “that can be taken once a day instead 2 to 3 times a day. A long acting drug and a pill with more than one drug or actions should be prescribed if possible.”
- Research with 359 patients found that patients “were significantly more likely to understand instructions with explicit time periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals….”
Numerous research articles, medical blogs, health websites, and other types of reports were consulted to see whether the specific questions about taking pills with or without meals, and taking a pill once a day, could be answered directly. We did not find research reporting on these specific questions, but found lots of related research that we have presented here as helpful findings.