Consequences of Non Adherence

Across illnesses, adherence is the single most important modifiable factor that compromises therapeutic outcome. The most efficacious treatment is made ineffective if the patient fails to adhere to it. Irrespective of whether non-adherence is intentional or non-intentional, it has substantial health and societal costs in terms of increased morbidity, mortality, and economic costs. A recent meta-analysis reported a 50% increase in the risk of adverse outcomes in non-adherent CHD patients.7 For example, in comparison to hypertensive patients who adhere, non-adherent hypertensive patients are four times more likely to be hospitalized or to die from CHD.8 In addition, the economic costs of non-adherence in the United States are considerable; a decade ago, it was estimated that medication non-adherence required $25 billion to pay for additional treatment and hospital admissions, and lost productivity due to non-adherence was estimated at $100 billion.9

Non-adherence produces unnecessary medical and psychosocial consequences of CHD, reduces quality of life, and wastes valuable healthcare resources. These consequences impair the ability of healthcare interventions such as CR to achieve therapeutic goals. Non-adherence produces increased need for expensive health services (e.g., hospitalization, outpatient clinic visits) due to disease progression or relapse. Furthermore, the patient's resumption and maintenance of normal social and vocational contributions is impaired. The development of strategies to promote adherence offers considerable potential to provide substantial medical, psychological, and economic gains. Before considering possible interventions, it is necessary to examine the main predictors of adherence identified in the literature.

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