Running Head: MEDICATION NON-ADHERENCE: A ROOT CAUSE ANALYSIS

Medication Non-Adherence: A Root Cause Analysis

Brianna H. DeValk
Bon Secours Memorial College of Nursing

Authors Note
Brianna DeValk is currently a Registered Nurse enrolled in the
Bachelor of Science Degree program at Bon Secours Memorial College of Nursing. On my
honor, I have neither given nor received aid on this assignment or test, and I pledge that I am in
compliance with the BSMCON Honor System. Any correspondence to this paper can be
directed to the Bon Secours Memorial College of Nursing student website and addressed in the
Nursing 3206 class discussion board.

MEDICATION NON-ADHERENCE: A ROOT CAUSE ANALYSIS

Medication noncompliance, otherwise known as medication non-adherence, is one of the

leading causes of hospital re-admissions, poor disease outcomes, and rising health care costs in
chronically ill patients. Adherence, an expression used somewhat synonymously with the term
compliant, describes the ratio (timing, dosage, and frequency) of prescribed medication doses
actually taken by the patient over a designated time period. In contrast, compliance is used
within the medical profession to describe simply whether or not the patient is following
providers orders; a far more passive approach to analyzing patient date. The term Adherence,
implies an active role in collaboration with a prescriber, and non-adherence encompasses the
diverse reasons for patients not following a treatment recommendation (Kalogianni, 2011, pg.
157). As a healthcare provider, understanding the reasons for non-adherence is necessary to
improve therapeutic effectiveness and overall patient health.
Patients presenting with HIV, Human Immunodeficiency Virus, and an actively
replicating viral load are among the chronically ill who absolutely must remain adherent to
prescribed medication regimens. Medications such as Stribild and Atripla, potent antiretrovirals,
are designed to be taken at the same time every day. These medications prevent the replication of
the HIV virus essentially allowing the body to fight-off the remaining viral components. HIV
remains within the patients blood stream, however, it is no longer transmittable. The patient
needs to remain consistent with daily medication administration in order to control this
replicatory process; if an extended period of time has lapsed between doses, the patient risks
developing a drug resistance thus leading to a loss of viroligic control. Identifying those with
adherence-related challenges that require attention and implementing appropriate strategies to
enhance adherence are essential roles for all members of the treatment team (Guidelines, 2014).
Several factors may contribute to medication non-adherence in patients with HIV. Early

MEDICATION NON-ADHERENCE: A ROOT CAUSE ANALYSIS

diagnosis of those at risk for developing behaviors associated with non-adherence is crucial
when treating patients with chronic diseases processes, like HIV. Construction of a fishbone
diagram assisted with the identification of a number of predisposing factors associated with nonadherence. These factors consisted of variances of: knowledge deficits associated with
medications/ doses/ purposes/ symptom management, deficient communication on behalf of the
healthcare provider, and economic hardship.
Formulation of the fishbone diagram began with the problem statement Non-adherence
with HIV medication regimen. Categories designated to further analyze causative factors are as
follows: Economic, Healthcare Provider, Complexity of Therapy, Condition: Timeline, and
Patient. All causes identified fit appropriately into the diagram. Inclusions within each category
are as follows:
Category
Economic

Healthcare Provider

Complexity of Therapy

Condition: Timeline

Patient

Inclusions
Cost
Unpredictable living conditions
Inadequate access to health care
Lack of established relationship with patient leading to a lack of
necessary encouragement and support.
Lack of communication regarding benefits of therapy, medication
instructions, and side effects
Length of Therapy
Number of Medications and associated doses
Inconvenience with patients schedule
Side effects of medication: impotence, heart burn, etc.
Absence of symptoms leads many patients to feel that their
condition has been managed. There is a severe lack of knowledge
regarding effects if medication suddenly stopped.
Adherence to medication regimens for chronic disease processes is
known to decline over time. Patients get tired of taking the same
medication, adhering to the same schedule, etc.
Intellectual Limitation
Physical Impairment
Substance Abuse

MEDICATION NON-ADHERENCE: A ROOT CAUSE ANALYSIS

Further categorization of causative factors was deemed unnecessary.

The root cause of medication non-adherence in HIV patients is far more complicated than
the diagrams indicates. Each HIV patient presents with a unique history and risk potential. The
key to maintaining patient adherence is early recognition of causative factors. Adherence is
better conceptualized as a variable behavior, rather than a trait characteristic: (Elliot, 2008, pg.
601). Medication non-adherence is a series of behaviors that may be mistaken as noncompliance. Quality patient healthcare provider interaction should reveal the potential for risks.
Therapeutic communication and behavioral reviews may then be incorporated into plan of care
so as ensure patient adherence to ordered medication regimen.

MEDICATION NON-ADHERENCE: A ROOT CAUSE ANALYSIS

References:
Elliott, R., Shinogle, J., Peele, P., Bhosle, M., & Hughes, D. (2008). Understanding
Medication Compliance and Persistence from an Economics Perspective. Value in
Health,11(4), 600-610.
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and
Adolescents. (2014, May 1). Retrieved October 22, 2014.
Kalogianni, A. (2011). Factors affect in patient adherence to medication
regimen. Health Science Journal, 5(3), 157-158.