Fact Sheet
When Patients Don’t Take Their Medicine: What Role Do
Doctors Play in Promoting Prescription Adherence?
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“Medicine left in the bottle can’t help.”
—Yoruba proverb
L
ack of adherence to prescriptions (that is, patients failing to take medicine either as instructed or at
all) afflicts medical care in the United States. Nonadherence affects up to 40 percent of older adults,
especially those with chronic conditions, and is associated with poor outcomes, more hospitalizations,
and higher mortality. The health care cost of nonadherence is estimated at $290 billion per year.
Prior RAND research has shown that some nonadherence is cost-related and can be addressed through
insurance benefit designs that keep copayments low.1
Physicians also play a key role in addressing nonadherence. Yet physician perspectives on their
responsibility for nonadherence and strategies for promoting adherence are not well understood. A team
from RAND; the University of California, Los Angeles; and the University of California, Davis, examined physicians’ views about their responsibility for medication adherence and explored how physicians
and patients discuss nonadherence. The team conducted focus groups with physicians in New Jersey and
Washington, D.C., and audiotaped primary care visits in Northern California doctors’ offices.
The results point to a contrast between what physicians believe and what they do:
■Although
physicians uniformly felt responsible for assessing and promoting medication adherence,
only a minority of them asked detailed questions about adherence.
■Although
providers often checked which medications a patient was taking, they rarely explicitly
assessed adherence to these medications.
■Many
physicians expressed discomfort about intruding on patients’ privacy to detect nonadherence.
In the office, they rarely asked about missed medication doses.
■Most
cases of nonadherence detected during office visits were revealed through unprompted patient
comments.
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Physicians’ reluctance to intrude has important implications for the vast array of new information
that is becoming available from pharmacy benefit plans, managed care plans, and other data repositories.
In addition, the reluctance to inquire that the physicians described contrasts sharply with the physician
role in the increasingly prominent concept of the medical home, where primary care doctors are envisioned as playing a central and active role in managing and coordinating care.
The authors conclude that addressing nonadherence will require a different approach than the one they
observed in the study. Given the importance of patients’ shared responsibility, a new paradigm that clarifies
joint provider-patient responsibility may be needed to better guide communication about medication
adherence. In this context, developing new protocols to guide discussions of adherence is worth exploring.
Solomon MD, Goldman DP, Joyce GF, and Escarce JJ, “When Drug Cost-Sharing Increases, Patients Newly
Diagnosed with a Chronic Illness Delay Starting Medication,” Santa Monica, Calif.: RAND Corporation, RB-9453, 2009
(http://www.rand.org/pubs/research_briefs/RB9453.html).
1
This fact sheet is based on Tarn DM, Mattimore TJ, Bell DS, Kravitz RL, and Wenger NS, “Provider Views About Responsibility for
Medication Adherence and Content of Physician–Older Patient Discussions,” Journal of the American Geriatrics Society, Vol. 60,
No. 6, June 2012, pp. 1019–1026 (EP-201200-175, http://www.rand.org/pubs/external_publications/EP201200175.html).
This fact sheet was written by David M. Adamson. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and
analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark.
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RB-9681 (2012)
CHILDREN AND FAMILIES
EDUCATION AND THE ARTS
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