Increasing medication adherence among cardiovascular disease patients requires a multidimensional approach, according to a state-of-the-art review published Jan. 23 in the Journal of the American College of Cardiology.

The review, led by Keith C. Ferdinand, MD, FACC, et al., summarized key background material from a symposium on medication adherence convened by the U.S. Food and Drug Administration (FDA) as part of the Million Hearts Campaign, and determined five key factors that affect medication adherence: socioeconomic factors, health care system-related factors, medical-condition related factors, therapy-related factors and patient-related factors. They found that socioeconomic, health care-systems related and therapy-related factors appeared to have the most influence on overall adherence rates.

Socioeconomic factors include unstable living conditions (including homelessness), lack of health insurance, lack of family or social support network, medication cost and limited English proficiency. Levels of education and literacy were also noted as important factors affecting medication adherence.

Health care systems-related factors include provider communication skills, lack of positive reinforcement from provider, poor access/missed appointments, patient information materials written at too high a literacy level, high drug costs/copayments and lack of continuity of care. The review noted that team-based care can be effective in increasing adherence and improving health outcomes.

Complex regimens, side effects, long regimens and prescription refill patterns across different time points were named as some of the therapy-related factors in nonadherence. “These findings suggest a need for common-sense approaches to simplifying regimens and clear logistics as critical factors in better adherence,” stated the authors. 

Moving forward, the FDA is partnering with a number of campaigns and initiatives dedicated to increasing medication adherence, and will continue to pursue improving access to generic medications, expanding post-market safety monitoring of medical products, exploring effective strategies to improve health literacy, requiring medication guides to be issued to consumers with certain prescribed medications, developing a framework by which to release up-to-date prescription drug product information to consumers, and more. 

Keywords: Alcoholism, Anxiety, Cardiovascular Diseases, Continuity of Patient Care, Depression, Drug Costs, Frustration, Health Literacy, Homeless Persons, Insurance, Health, Medication Adherence, Mental Health, Motivation, Pharmacists, Physician Assistants, Prescription Drugs, Social Conditions, Social Support, Socioeconomic Factors, United States Food and Drug Administration, Secondary Prevention

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