Assessment of medication adherence patterns and various causes of non-adherence in long term therapies in a tertiary care hospital

Medication non-adherence is a multifaceted problem, especially for people with chronic diseases. The study objective was to assess adherence to long-term medications among patients in general medicine department of an Indian tertiary care teaching hospital and to evaluate the relationship between medication adherence and socio-demographic variables and to assess various causes of nonadherence.

A prospective observational study was carried out in a tertiary care hospital, in Kerala, South India over six months in which 237 patients were selected for medication adherence patterns, causes and risk factors of nonadherence. Interviewer assisted survey was conducted to assess adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4), various causes of nonadherence were assessed using various dimensions of adherence. Sociodemographic variables concerning low adherence were also assessed.

Low adherence was reported by 43.5%, 28.7% had medium adherence and 27.8% had high adherence. Low adherence was significantly associated with lower age, male gender, urban residence, higher socioeconomic status and employment. Most of the reasons for nonadherence were patient-related reasons (62.9%). Among that forgetfulness (18.6%) and fear of dependence (13.9%) was the reason for the greatest number of patient-related reasons. Relation of adherence rates with the type of therapy, polypharmacy and multiple comorbidities showed no statistically significant relation.

A very high level of low medication adherence was seen in the general population. As clinical, patient counselling and education, and healthcare policy initiatives are directed to tracking the problem of low medication adherence, these should be priority populations for research and interventions.