Encouraging adherence to long-term medication

Non-adherence to medicines is common in patients with chronic disease and in those prescribed preventive medication. It can be intentional, unintentional, or both. Non-adherence reduces the effectiveness of prescribed medicines and may lead the prescriber to escalate treatment unnecessarily and potentially dangerously. Patient education, shared decision making, pharmacist support and motivational interviewing reduce intentional non-adherence. Interventions to reduce unintentional non-adherence address patient factors including misunderstanding, confusion or forgetfulness, and factors beyond the patient's control such as cost. Patients should be asked about adherence at every consultation. A collaborative communication style is effective, using the patient's own expressions and responding to their cues. Normalising non-adherence, and starting with open questions then following up with more specific probes, can also help. Electronic reminders, such as text messaging, have been shown to increase medication adherence.