Noncompliance Rates

Keep watch also on the fault of patients which makes them lie about taking of things prescribed.
-Hippocrates, circa 500 B.C.
Drugs don’t work if people don’t take them.
-C. Everett Koop, 1985

Overall Rates of Noncompliance

  • 20% of all prescriptions that are written are never filled (Koop, 1985).
  • Up to 60% of all medication prescribed is taken incorrectly, or not at all (National Council on Patient Information & Education, 1995). Noncompliance includes not filling the prescription, overmedication, forgetting to take medication, deliberate under-dosing, taking the wrong medication, taking the right medication at the wrong time, taking someone else’s medication, and hoarding old medications to take later.
  • 90% of elderly patients make some medication errors, and 35% make potentially serious errors. Older adults average 2.3 serious medication errors per patient per month (Green et al., 1985).
  • 50% of all long-term medications are abandoned in the first year (Meichenbaum & Turk, 1987).
  • Recently, higher pharmacy copayments have caused up to 40% increases in noncompliance (Dalzell, 1999).
  • Even patients who understand and agree with treatment are only 75% likely to comply (Cramer, 1995).
  • Even healthcare professionals take only 80% of their medications correctly (Meichenbaum & Turk, 1987).
  • Patients quite possibly are less compliant the more serious their condition. In one study, only 42% of glaucoma patients met minimal criteria for compliance after having been told they would go blind if they did not comply. Among patients who already had gone blind in one eye, compliance rates rose only to 58%! (Meichenbaum & Turk, 1987).

Costs of Noncompliance

  • About 225 million hazardous situations are created each year by noncompliance (Smith, 1985).
  • An estimated 125,000 lives could be saved annually with better compliance (based on heart disease only: Smith, 1989).
  • Altogether, patients' failure to take prescribed medication costs society about $100 billion annually (National Council on Patient Information & Education, 1995). Approximately $47 billion of this cost is associated with 8.8 million drug-related hospitalizations per year (Friend, 1995).The noncompliant patient's average cost per hospital admission is $2,150, in 1990 dollars (Col, Fanale, & Kronholm, 1990).
  • Noncompliance is directly responsible for the admission of 380,000 patients to nursing homes each year (23% of all nursing home admissions: Smith, 1985). In 60% of all nursing home admissions, noncompliance is a greater factor than the person’s actual medical condition (Meichenbaum & Turk, 1987).
  • Noncompliance leads to 3.5 million hospital admissions annually, or 11% of all admissions (E-pill, 1999). In the elderly, 40% of all admissions are due to medication-related problems (Balkrishnan, 1998).The mean cost per admission in these cases has been estimated at $2,150. These patients' cost per admission is almost $90,000 (National Council on Patient Information & Education, 1995).
  • Noncompliance is the greatest single cause for readmission to hospitals (Meichenbaum & Turk, 1987).

Problems with the Assessment of Noncompliance

  • Physicians are unable to predict patients’ noncompliance at rates better than chance (Roth, 1987).
  • When a medical professional asks about compliance, patients tend to exaggerate ("white coat" effects). Therefore, patients’ self-reports usually overestimate compliance by a significant amount (Roth, 1987).
  • Combinations of measures actually tend to be less accurate than self-report alone (Atkin & Ogle, 1996).
Noncompliance By Diagnosis Noncompliance By Drug Type
Gastrointestinal Disease:84% Antiarrythmics80%
Osteoporosis:82% Lipid-Lowering Agents:72%
COPD:80% NSAIDs:70%
Alzheimer's Disease:75% Antihypertensives:65%
Diabetes:73% Antidepressants:61%
Arthritis:70% Anticoagulants:60%
Glaucoma:66% Anticonvulsants:54%
Benign Prostatic Hypertrophy:64% Anti-Parkinsonian Drugs:52%
Schizophrenia:60% Immunosuppressants:50%
Migraine:56% Psychostimulants:50%
Epilepsy:54% Estrogen Replacement:45%
Breast Cancer:53% Nonsedating Antihistamines:44%
Seasonal Allergies:44% Oral Contraceptives:33%

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