Non-Adherence and its threats


Everyone is aware that the healthcare industry is one of the most expensive industries worldwide. The figures show that in a developed country such as the US, the annual healthcare expenditure amounts to over 2.5 trillion USD. This is an important source of income for the nation as well, with the medical sector making up almost 18% of the national GDP. These figures are expected to rise to almost 21% by the year 2023. Several NGOs have come out with claims that of the total medical expenditure almost one-thirds is wasteful expenditure which can be avoided. One might argue that it’s just a small amount and it comes as part and parcel of the industry. But let me remind you at this moment that one-third of just the US expenditure is almost a trillion dollars annually. The major cost of increased expenditure is patients not complying to their doctor’s advice resulting in the condition getting worse, leading to additional expenditures and even in some severe cases, death. The number of deaths as a result of non-compliance are much more than one would assume. Statistics put non-adherence related deaths at over 100000 annually. Non-compliance or Non-adherence continues to be the greatest threat that the medical industry faces. Whether it be the kid who doesn’t want to take his medication due to it tasting weird or the senior citizen who just doesn’t want to visit the hospital on a frequent basis, the threats posed by such negligence are very real and cannot be ignored.

What exactly is Non-Adherence?

Non-Adherence to treatment refers to the unwillingness of the patient to take the drugs at the prescribed dosage or adhering to the time intervals suggested by the medical practitioner. This can be better explained with the jargon Medical persistence; it is defined as the duration if time from the initiation of the treatment procedure till the end of the therapy. We talked about the wasteful expenditures earlier. Non-adherence to treatment demands leads to a vicious circle of deteriorating health conditions which leads to additional complications requiring other treatments which require additional medications. The patient may take lightly on the new treatment plan as well and the circle continues itself. This leads to an increased utilization of services leading to an increased expenditure in turn, all of these amount to a higher patient expenditure.

What if we just run out of antibiotics?

The problem of running out of antibiotics is not one that should be taken in the literal sense. It doesn’t mean that one day we wake up and all the stock is over and there is no more antibiotics. Rather, all the antibiotics in pharmacies and hospitals worldwide have been rendered useless by superbugs. This sounds like the story of a zombie apocalypse movie but the threat of this happening is very real. Even now antibiotic resistant superbugs are already present. The problem arises due to antibiotics being used too much. This gives the organisms more sample space to develop an immunity to the antibiotic. How is this related to non-compliance? Well non-adherence to medical advance works on two ends of the spectrum. There are people who are reluctant to take medicines and there are others who are too keen. Whatever the cause of their actions might be, patients end up consuming antibiotics or medicines in general above the prescribed dosage. This is why governments are discouraging using antibiotics without an actual need for it or more accurately, without a doctor recommending it. Governments are aware of the Multi drug resistant Tuberculosis (MDR-TB) and Totally drug resistant Tuberculosis (TDR-TB) strains that have developed in recent times. Use of antibiotics in sub optimal dosages are also a reason for developing resistance. The dosage will not be enough to kill the bacteria or microorganism but will be enough for it to adapt and develop a resistance.

How can someone be forced to take their medicine?

The DOTS (Directly observed Treatments, Short course) was one of the earliest campaigns started by WHO to control the spread of tuberculosis and administer therapy. We can take inspiration from one of the steps that was part of this program. Ensuring that the patient completes his dosage, and also takes the correct dosages at the correct time was something that was closely monitored during the program. Of course, one can argue that monitoring every patient worldwide to take his medicine on time is impractical. This is true and that is why the thinking caps need to worn across a world to come up with an innovative solution to this problem. Scientists claim that the person who comes up with a way to enable magnetic levitation at room temperature will revolutionize transport as we know it and will also end up being very rich. This is the medical equivalent of the same problem.

Unlike magnetic levitation, one can start small when it comes to medical adherence. The baby steps have already been taken by a company called Medi Safe. It offers a phone or computer application that reminds you to take your medicine on time and in case you do not respond, it alerts another person whom you provided the contact information for, to do the same. The drawback of this is that it doesn’t deal with the people who intentionally refrain from taking medicines for various personal reasons. Also access to a mobile and computer is not something that is available worldwide.

Another interesting concept has been introduced by PillPack. The company packs medications and sends them by post on a daily or weekly basis. This prevents the patient from having access to more medicine than he needs daily. The pills are packaged according to the date and only sent on the mentioned date or at maximum, one day prior. This is especially helpful for the elderly who often have to take 10 tablets a day and this better organizes it for them.

The Upside Down

The most important problem that a patient has with such systems is a simple psychological effect. What does every patient loath? The constant reminder that he is a patient and that he is dependent on medicines. And this is what exactly all these systems remind them. It may sound trivial when we read this, but for a man who has been suffering from a disease and has been taking medicines for the last 10 years, it is a much different story.

Till a perfectly working system is developed by someone, the threat of non-adherence is something that the healthcare industry will always have to be wary of.

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