Medication adherence is defined as the patient’s ability to effectively manage timing, dosing, and frequency of all medications prescribed by a healthcare provider. If a patient takes less than 80 percent of their prescribed medication(s), they are considered nonadherent.

Nonadherence to medications has been documented to occur in >60% of cardiovascular patients. In persons with cardiovascular disease poor medication adherence has been associated with about twice the risk of death and it associates with other unfavourable health related behaviours such as smoking, a poor diet, lack of physical exercise, and failure to seek medical advice for cardiac symptoms. Moreover, most patients who decide not to fill a prescription or take a medicine will not tell their doctor.

Primary nonadherence (not initially filling the prescription written) leads to a significant increase in 1-year mortality after hospitalization for myocardial infarction. Secondary nonadherence (failure to follow the instructions or to refill the prescription) has been shown to increase mortality, hospitalizations, and costs.

The need to take preventive medication may be difficult to grasp for many patients, because these drugs do not generally improve symptoms and benefits are based on statistical concepts of risk but patients need to understand these treatments reduce risk even when cholesterol and blood pressure are not elevated.

Factors of nonadherence include socioeconomic factors (inability to afford or difficulty in affording their medication), effective communication (providing medication instructions at a level that the patient can understand), lack of coordination of care by multiple providers or lack of motivation (lack of understanding the gravity of their illness or the benefit that the medication will provide)

Solutions to overcoming patient-specific barriers to nonadherence include monitoring prescription refills, counting pills, and involving friends or family members, ask patients what pharmacy they use, who their insurance carrier is, or what their current profession is and asking patients to explain the reason they are prescribed each medication.

Reducing the actual dosing time of medications to once daily supports a 56% decrease in non-adherence. The “polypill’, which combines several medications in a single capsule is a strategy designed to both reduce costs and improve adherence.

Nurses play a key role in educating patients about their medications and complex regimens. It is essential to create a blame‑free environment to discuss medications with the patient. As older adults have the greatest difficulty with adhering to their medication regimen, so age-appropriate assistance with medication adherence may be needed.

For common barriers such as having too much medicine to take or forgetting to take medications, there are myriad existing electronic tools available which could include electronic health record systems that already inform medication reconciliation or medication reminders in the form of smartphone apps.