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Understanding Mental Barriers to Patient Medication Adherence

Negative patient beliefs about medicine are a more powerful barrier to medication adherence than external barriers.

Negative patient beliefs contribute to medication adherence barriers.

Source: Thinkstock

By Sara Heath

- Clinicians looking to improve medication adherence amongst their chronic illness populations should look beyond the external barriers patients face. Clinicians must also be aware of the emotional and behavioral barriers patients face, according to a study published in the Journal of the American Board of Family Medicine.

Medication adherence is a core factor supporting chronic care management plans. Patients who do not take their prescribed medications face adverse health results and increased medical costs due to more system utilization. High medication non-adherence results in up to 125,000 deaths and $290 billion medical costs annually, the research team reported.

Clinicians must understand what is keeping a patient from taking her prescriptions to improve medication adherence rates. Much research has been done on both the external and mental barriers to taking medications, but little has been done to put either variable in the context of the other, the researchers said.

The team administered a survey asking patients about their medication adherence habits, beliefs about medication, and external barriers to obtaining medication such as cost or access to a pharmacy. This survey of 343 patients worked to determine whether external of mental barriers were more pressing with regard to medication non-adherence.

Fifty-four percent of patients reported low medication adherence. This statistic may be underreported because the patients were in charge of reporting and categorizing their level of adherence, the researchers noted.

Fifty-one percent of patients reported at least one external barrier to receiving their medications. Most patients reported cost barriers, but the researchers also maintained that concerns about adverse side effects keep patients from taking their medications.

Patient beliefs about medication were more negative than positive, the researchers said. Fifty-two percent of patients reported negative beliefs about medication compared to 48 percent reporting positive beliefs. Patients who had negative beliefs about medication were about half as likely to take their medications than those who had positive beliefs.

Patients also reported various negative beliefs about their medications, each in a different strain and affecting medication adherence in a different way, the researchers pointed out.

“The most commonly reported negative belief about medicines was fear of dependence, but this did not have the greatest association with adherence,” the team wrote. “Though reported less frequently, if patients did not feel that their doctor understood them or if they were taking alternative medications, they were less likely to take medicines as prescribed.”

Overall, negative beliefs about medications were just as prevalent as external barriers to medications, the researchers said. However, when a patient had negative beliefs, those beliefs were more influential and prohibitive than the external barriers.

Therefore, clinicians must look at external barriers keeping patients from their medications (although those are pressing), as well as at patient beliefs about medication, the researchers argued.

“When we examined barriers to getting medicines and strong negative beliefs about medicines in the same predictive model, we found that beliefs—not barriers—have a significant effect on adherence,” the researchers explained. “Even in a population experiencing considerable barriers to medication adherence, negative beliefs are a larger obstacle.”

Understanding patient belief systems about their medications is critical because it requires a different clinician skill set to resolve. Clinicians must employ their interpersonal skills rather than set up cost-cutting strategies. Solutions such as subsidies, payment plans, and other financial strategies can help mitigate cost burdens and improve medication adherence.

While it is certainly not a simple task to reduce drug prices, these strategies require a different approach than trying to change a patient’s mind. Overcoming mental barriers to medication adherence will require a change in clinician communication.

The strongest predictor of negative beliefs and medication non-adherence was the feeling that clinicians did not understand their patients. This barrier must be resolved by more meaningful and empathetic patient-provider communication.

“Patients' beliefs that they may become dependent on medicines, that their medicines disrupt their lives or otherwise worry them, that their medicines are ineffective, and that their doctor does not understand them all contribute more to nonadherence than external barriers to getting medication prescriptions filled,” the researchers concluded.

“These findings suggest that in order to reduce chronic disease mortality by improving adherence rates, prescribing physicians should identify and address the range of negative beliefs that patients hold regarding adherence to medicine regimens.”

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