Why Patients Are Noncompliant with Treatment

It may seem obvious, even non-negotiable, that if your healthcare provider gives you a prescription, you'll have it filled by your pharmacist and you'll take it as directed; if he or she gives you a referral to a specialist or recommends lifestyle changes, you'll follow through. In fact, a surprising number of people in the United States do not follow through on treatment plans—a problem known as noncompliance or non-adherence.

Man holding pill medication
Paul Bradbury / Getty Images

Research on Noncompliance

According to the World Health Organization (WHO), approximately 125,000 people with treatable ailments die each year in the United States because they do not take their medication properly.

Not taking medication as prescribed can account for up to 50% of treatment failures. The WHO also reports that up to 25% of hospital admissions result from patient noncompliance.

Numerous studies back up the prevalence of patient noncompliance. A 2012 review in the Annals of Internal Medicine reported that 20—30% of medication prescriptions are never filled and that approximately 50% of medications for chronic disease are not taken as prescribed.

Even those at high risk of serious complications often resist following treatment regimens. A 2016 study found that a third of kidney transplant patients don’t take their anti-rejection medications. An estimated 50% of patients with cardiovascular disease and its major risk factors have poor adherence to prescribed medications.

Needless to say, when patients don't follow through with the treatment decisions they have made together with their healthcare providers, it can cause additional problems. They may not get over their sickness or injury. They may get even sicker or injure themselves further—or worse.

Former Surgeon General C. Everett Koop put it bluntly: “Drugs don’t work in patients who don’t take them.” 

Reasons Patients Don't Comply 

Research published in 2011 suggests that some of the main reasons patients do not adhere to treatment plans include:

  • Denial of the problem: Many diseases and conditions are easy to ignore, even when they have been diagnosed. This is particularly true for diseases that are asymptomatic, meaning they don't have noticeable symptoms that bother the patient. For example, if you have diabetes or hypertension (high blood pressure), you may not have symptoms that get in the way of everyday life. You may not even have known you had the condition until it showed up on a routine examination.
  • The cost of the treatment: Your medications and therapies may or may not be covered by insurance, and the more out-of-pocket costs you have, the less likely you are to buy the drugs or make treatment appointments.
  • The difficulty of the regimen: Patients may have trouble following the directions, particularly if they have memory problems or dementia. For example, taking a pill in the middle of the night, or being unable to open a "child-safe" container, may create a barrier to compliance.
  • The unpleasant outcomes or side-effects of the treatment: Any perceived negative— such as an unpleasant taste of medicine, the prick of a needle, or the pain of physical therapy—may keep you from following through. Also, patients may be reluctant to start a medication after reading about the possible side effects.
  • Lack of trust: If for whatever reason, you don't believe your treatment is going to make a difference in your health, you may not be motivated to comply.
  • Apathy: When you don't realize the importance of the treatment, or you don't care if the treatment works or not, you are less likely to comply.
  • Previous experience: Especially in the cases of chronic or repeat conditions, patients will sometimes decide that a treatment didn't work in the past, so they are either reluctant or unwilling to try it again.

What Can Be Done?

Healthcare experts continue to study the reasons behind patient noncompliance and are working to find solutions on their end. If you are a patient and are finding it difficult to adhere to your treatment plan even though you'd like to, here are some things you can do that may help:

  • Ask questions: If you don’t understand something about how to take your medications when to take it or side effects you might experience, ask your healthcare provider or your pharmacist for help. If you think you might have trouble understanding your practitioner or pharmacist, ask a friend or loved one to go with you to listen, help you, and take notes. The FDA has information on how to take medications as prescribed.
  • Get a pill container: Many types of pill containers are available at drugstores. Some are divided into sections for each day of the week and time of the day. Some pharmacists will even prepare blister packs for daily or weekly medications.
  • Keep a "medicine calendar" near your medicine: Make a checkmark every time you take your dose.
  • Tell your healthcare provider if paying for prescription drugs is a problem: Your practitioner may be able to prescribe a generic medication or offer other suggestions to offset the cost of a drug. (Generic drugs can cost 80 to 85% less.) Some pharmaceutical companies also offer assistance programs for those who qualify.
  • Take advantage of technology: Thanks to modern technology, there are a number of devices that have been designed to help patients adhere to a prescribed medication schedule. These include medication reminder pagers and wristwatches, automatic pill dispensers, and even voice-command medication managers. You can also set alarms on your smartphone. Ask your pharmacist for suggestions as to which particular devices may be helpful for you.

If you find yourself tempted not to follow through on your treatment, contact your healthcare provider to share your reasons, and together, to the extent it's possible, work out an alternative you both can agree on. Remember that noncompliance can have dire consequences.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kim J, Combs K, Downs J, Tillman F. Medication Adherence: The Elephant in the Room. US Pharm. 2018;43(1)30-34.

  2. Viswanathan, M. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic reviewAnn Intern Med. 2012;157(11):785-795. doi:10.7326/0003-4819-157-11-201212040-00538

  3. Patzer, R, et al. Medication understanding, non‐adherence, and clinical outcomes among adult kidney transplant recipientsClinical Transplantation. 2016;30(10):1294-1305. doi:10.1111/ctr.12821 

  4. Kronish I, Ye S. Adherence to Cardiovascular Medications: Lessons Learned and Future DirectionsProg Cardiovasc Dis. 2013;55(6):590-600. doi:10.1016/j.pcad.2013.02.001

  5. Brown MT, Bussell JK. Medication adherence: WHO caresMayo Clin Proc. 2011;86(4):304–314. doi:10.4065/mcp.2010.0575

  6. American Heart Association. Taking control of your medications.

By Trisha Torrey
 Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.