Forgetfulness: You’ve picked up and paid for your medicine – but did you remember to take it? Forgetfulness is sometimes cited as a reason for non-adherence, particularly among patients who take a number of medications.

Personal beliefs:  If you don’t think the medicine is really going to work or that it may harm you, you may not take it as directed. “In one of [our earlier] studies, we found that people who generally believed that medications were not as beneficial as other people did were more likely to be non-adherent, or they reported themselves as missing more medication dosages than people who found medications useful,”  says Dr. Suarez-Almazor.  She believes this is perhaps the most challenging adherence factor for doctors, because patients don't usually talk about these beliefs unless they have a very good relationship with their doctor.  

Additionally, researchers at University Medical Centre Rotterdam in The Netherlands conducted an extensive literature search to better understand the reasons for nonadherence among patients with rheumatoid arthritis or undifferentiated inflammatory arthritis.  In the August 2013 issue of Seminars in Arthritis and Rheumatism, they reported that a patient’s belief in the necessity of disease-modifying antirheumatic drugs (DMARDs) was the strongest factor in adhering to therapy, says study leader Annelieke Pasma, a researcher in medical psychology and psychotherapy who has focused on medication adherence in rheumatology patients.

Pasma interviewed patients who did or did not take their medications as directed and discovered that the following factors also play a role in adherence:

• How much you communicate with and trust your doctor
• How much information you have about the medication
• Your previous experiences with medication
• The severity of your symptoms
• Your ability to adjust your life to the medication regimen
• Your desire to be involved in your treatment decisions, rather than just “following the doctor's orders.”

How to Improve Adherence
There are several things you and your doctor can do to improve medication adherence and your treatment outcome.   A trusting relationship with your doctor is crucial.  You should feel comfortable asking your doctor questions about your medicines and how they work.

Tips to Reduce the Cost of Medication

• Buy generics, when available.
• Ask if pill-splitting is okay. A one month-supply of a stronger pill (if it can be safely split) can cost just a fraction more than a lower dose, but it may provide two months’ worth of treatment.
• Ask about a different drug in the same medication class. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, can range from a few dollars to a few hundred dollars a month.
• Ask for samples. Pharmaceutical companies often give doctors samples of their medications. This isn’t a long-term solution, but it can help you reduce costs while waiting to see if a new medicine works.   
• Seek financial assistance.  Many drug manufacturers and organizations have assistance programs for patients who cannot afford their medication. You can find a list of programs here.  
• Lend your support. The American College of Rheumatology encourages patients and doctors to support The Patients' Access to Treatments Act of 2013 (H.R. 460), which would limit cost-sharing requirements for medications placed in a specialty tier. The bipartisan legislation would make certain medications more accessible by reducing excessive out-of-pocket expenses. Contact your lawmaker by visiting the Legislative Action Center

Tips for Getting Your Medicines

• If your doctor's office fills prescriptions, schedule your appointment for the same time you need a refill.
• Consider a mail order pharmacy.  Some pharmacy chains (like CVS, Walgreens, Walmart and others) also offer home delivery.
• Ask a family member or friend to pick up your medicine.

Tips for Remembering to Take Your Medicine

• If you take your medicine with meals, try storing your medicine with your dishes.
• If you take your medicine in the morning or evening, store your medicine next to your alarm clock or toothbrush.
• If you have a smart phone, set an alarm for your medication time.
• Ask your pharmacist how to get a pillbox with an alarm.