Is medication nonadherence a medical condition?

Zachary Marcum, Mary Ann Sevick, and Steven Handler in JAMA:

Medication nonadherence is widely recognized as a common and costly problem. Approximately 30% to 50% of US adults are not adherent to long-term medications leading to an estimated $100 billion in preventable costs annually. The barriers to medication adherence are similar to other complex health behaviors, such as weight loss, which have multiple contributing factors. Despite the widespread prevalence and cost of medication nonadherence, it is undetected and undertreated in a significant proportion of adults across care settings. According to the World Health Organization, “increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments.” How can adherence be improved? We propose that the first step is to view medication nonadherence as a diagnosable and treatable medical condition.

Whoa! That was unexpected. It ought to spark conversation at the next cocktail party, that is if you happen to attend a cocktail party for doctors and health policy wonks.

I don’t have a lot to add other than some questions: Are behaviors themselves medical conditions? Or are behaviors usually symptoms of the thing we call a condition? For instance, selling all your possessions to get high is an unhealthy behavior, but it isn’t the condition. Drug addiction is. Which do we treat? (That’s rhetorical.) Is medication nonadherence more like drug addiction or more like the thing drug addiction makes you do? If the latter, what’s the real, underlying condition?

Related to all this is, why don’t drug companies do more to promote medication adherence? Don’t they have a business interest in people using more of their products? I think someone once wrote me about some legal obstacle to drug companies promoting adherence in some way, but I don’t recall what the issue was.

Also, isn’t the hospital that is now at the center of an ACO much more interested in medication adherence than it used to be? Pre-ACO, the hospital earned greater revenue if its patients didn’t take their meds and ended up back in the ED or OR. Now, as an ACO, perhaps the hospital has a greater incentive to treat the condition more cheaply. If that’s possible with drugs, adherence should be paramount.

Your thoughts welcome.


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