BackImproving medicine adherence to fight India’s NCD burden
One in two patients do not take their treatments as directed, and one-third of patients who take medicines stop their treatments earlier than directed. This challenge is clear across diseases – including diabetes, hypertension, and hyperlipidemia. The opinion piece has been authored by Dr Agam Vora, General Secretary, Association of Physicians of India
PremiumIndia has a higher non-communicable disease burden (NCD) than most nations, with NCDs accounting for roughly 65% of all deaths in the country. While many of these conditions can be managed and treated – especially with new, evidence-based treatment options launched nearly every year – the numbers of cases are not declining. One core reason for this is poor adherence to medications, which is becoming an increasingly pressing public health challenge.
One in two patients do not take their treatments as directed, and one-third of patients who take medicines stop their treatments earlier than directed. This challenge is clear across diseases – including diabetes, hypertension, and hyperlipidemia. In fact, up to a third of people with diabetes do not even get their medicines to begin with. This is becoming a growing concern, especially with 76.6% of people living with diabetes showing uncontrolled blood sugar levels in India, according to a study.
Non-adherence has a devastating social and economic impact around the world. For instance, poor adherence in Europe contributes to 200 thousand premature deaths per year. Further, it costs Europe 125 billion euros in excess healthcare services, every year, with similar – and significant – costs to total healthcare expenditure observed around the world.
To address the complex challenge, it is important to first understand the various barriers to adherence. We know that, while 22.4% of patients state ‘forgetting’ as their main reason for non-adherence, recent studies have shown that providing reminders are only helpful if people are motivated to take their medicines. What this means is that we must dig deeper, using theory-driven behavioural science interventions to understand and support better patient health by looking at adherence as a behaviour, requiring motivation that can result in action.
Factors driving non-adherence can be related to patient awareness, such as inadequate knowledge about therapy, lack of or changing routines, stress, or illness or medication related, including a lack of visible symptoms, poor understanding of disease, fear of side effects, complex medication regimens, or treatment fatigue.
Beyond these, other explanations of non-adherence include socio-cultural beliefs, including a lack of belief in the need for treatment, stigma, preference of alternative medicines. For instance, as per a study conducted in the Kempe Gowda Institute of Medical Sciences and Research Centre in Bangalore, 39% of patients reported not taking their treatment due to specific beliefs about their treatment.
Other prominent factors include economic or logistical reasons, like financial worries and high cost of medicines, medicine shortage, or lack of access to healthcare. Certain barriers to adherence are especially common in developing countries, including the urban-rural divide in healthcare resources, and short primary care consultation times. Worryingly, doctors only spend an average of 1.5 minutes with their patient in India, as compared to 22.5 minutes in Sweden. This calls to question what information might be left unsaid – regarding symptoms to stay alert to, the condition, and one’s treatment – which can widen the patient-practitioner gap.
To help our patients build better health habits, we must adopt a patient-centric approach to care and understand their specific concerns that stop them from taking their medicines. By helping improve adherence, we can help prevent or delay the onset of complications, reduce hospitalization risks, and decrease healthcare costs, especially across therapy areas including hypertension, diabetes, and congestive heart failure – the benefits are endless.
But to see results at scale, we must look to engage the broader medical community, while also seeking insights from behavioural science experts, in this discussion. Collaborative, multi-stakeholder ecosystems or platforms do just this, creating a space to discuss challenges from our everyday experiences in the clinic, and best practices to tailor solutions that can help a diverse group of patients.
While there is considerable work to be done to achieve universal medicine adherence, we can be optimistic of the healthcare sector’s progress in recognizing the challenge of non-adherence and spearheading efforts to address it, as was evident at a company’s conference called a:care Congress 2022, which provided some tangible solutions to the issue of non-adherence based on behavioural science. Its interventions like these that can help improve our fight against India’s non-communicable disease burden, while also tackling other health challenges.
The opinion piece has been authored by Dr Agam Vora, General Secretary, Association of Physicians of India
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