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Better Adherence, Better Clinical Outcome

World Health Organization (WHO) describes medication adherence as “the degree to which the person’s behaviour corresponds with the agreed recommendations from a health care provider”.

To conclude, it refers to the willingness of patient to take their medications as prescribed and whether they want to continue to take the medications as prescribed.

Although Malaysia is ranked among the top in the world for its healthcare system and Malaysians are provided with great and accessible healthcare, only a small number of patients achieve optimal control for this disease.

Evidently, a majority of people in Malaysia do not adhere to their long term medications.

  • 4.7 million patients have adherence issue for high cholesterol medications
  • 2.1 million patients have adherence issue for diabetic medications
  • 3 million patients have adherence issue for hypertension medications

As a matter of fact, a study by Hassali et al. concluded a high return rate for unused medication in government hospital.

The study calculated the cost of returned unused medication was about RM42.35/patient. In other words, the estimation cost across Malaysia may total up to millions Ringgit per year.

Relationship between adherence and long-term disease

Patients are advised to adhere to their medications. Evidently, this may help to reduce the progression of their disease and achieve optimal control.

According to WHO, increasing adherence may have greater effect on health than improvements in specific medical therapy.

On the contrary, low adherence may result in faster progression of disease.

Therefore, this may contribute to high healthcare costs, poor treatment outcome and poor quality of life.

So, why don’t people take their medications as directed?

There are several reasons why patients don’t take their medications such as :

  • Forgetfulness
  • Complex regimen
  • Lack of understanding of the disease
  • Patient do not experience symptoms of the disease
  • Medication cost

Improving adherence

Many interventions have been carried out, aiming to improve medication adherence. These can be classified into different categories, for example:

  1. Technical intervention

    Special packaging such as pill box
    Dosage simplification

  2. Behavioural intervention

    Reminders such as reminder by SMS or alarm

  3. Educational

    Educating patient about the disease

  4. Social support

    Buddy system

  5. Structural intervention

    Disease management program

Hence, there are multiple strategies that can be applied to prevent this issue.

Medication adherence is not the sole responsibility of patients.

In conclusion, physicians and patient must work hand-in-hand to identify the key factor of poor compliance to combat this issue.

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American Heart Association. Medication adherence–taking your meds as directed.

Aziz, H., Hatah, E., Makmor-Bakry, M. et al. Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia.

Hassali MA, Supian A, Ibrahim MI, Al-Qazaz HK, Al-Haddad M, Salee F, et al. The characteristics of drug wastage at the hospital, Tuanku Jaafar Seremban, Malaysia: a descriptive study.

World Health Organization. Adherence to long-term therapies: Evidence for action [Updated 2003]

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