Healthcare professionals should spend sufficient amount of time with their patients in order to elicit information on barriers to medication adherence.Good adherence to medications contributes to a reduced risk of death in adults with chronic disease, while non-adherence may increase such risk by up to 45 percent, reports a South Africa study.
“However, the review of legislative and policy documents suggests that government efforts are focused primarily on surveillance rather than strategy or preventative measures,” the researchers said.
“This strong evidence should motivate incorporating adherence-based risk assessments into clinical and legal frameworks,” they added.
Three databases (ie, PubMed, Medline, and Scopus) were searched for articles published in English after March 2024 and with study populations >18 years of age. The researchers also obtained and analysed South African health legislation and professional guidelines from 2014 onwards using search terms aligned with the systematic review strategy.
Twenty-six articles met the eligibility criteria. Effect measures (eg, hazard ratios [HRs]) from individual studies were categorized according to adherence levels: good, intermediate, poor, and non-adherent. Seventeen measures were reported for good adherence and 44 for intermediate, poor, and non-adherent categories. [Br J Clin Pharmacol 2026;92:360-373]
Pooled estimates showed the highest risk of mortality for patients with poor adherence (HR, 1.63, 95 percent confidence interval [CI], 1.36‒1.96) and non-adherence (HR, 2.77, 95 percent CI, 2.3‒3.34).
Mortality-related terms (1.323 and 2.98 matches per 1,000 words for ‘mortality’ and ‘death’, respectively) were found to be significantly greater than adherence-related terms (0.053‒2.98 matches per 1,000 words) in the review of health legislation and professional guidelines.
Furthermore, there was low co-occurrence between medication adherence-related search terms (ie, MARS, adherence, medication adherence, adhere, non-adherence, and medication compliance) and mortality-related search terms (death, mortality, and survival) within documents analysed.
Disease control
These findings are consistent with previous studies that show the association between medication adherence and disease control measures such as blood pressure and blood glucose levels. [PLoS ONE 2022;17:e0274971; Blood Press 2021;30:143-144]
Previous systematic reviews and randomized controlled trials have also reported how intervention to enhance medication adherence could improve disease markers and reduce hospital admissions. [J Am Heart Assoc 2016;5:e002606; Res Soc Admin Pharm 2019;15:1057-1067; J Med Internet Res 2016;18:e91; J Pharm Pract 2021;34:480-492; J Behav Med 2016;39:1065-1075]
“Although the evidence favouring improving mediation adherence is strong given its effect on clinical outcomes, assessing the potential economic impact is also prudent,” the researchers said. “Available evidence does suggest that adherence interventions are cost-effective or cost-saving, further reiterating the value of focusing on this aspect of chronic disease management.” [Expert Rev Pharmacoecon Outcomes Res 2016;16:67-84]
Standardization
The role of medication adherence remains understated in clinical guidelines and health policy frameworks in South Africa, according to the researchers, noting the need to standardize adherence assessment methods and to develop cost-effective intervention that could improve adherence.
“Furthermore, South African policymakers should prioritize integrating adherence metrics and interventions into national clinical guidelines and relevant legislation, ensuring that evidence-based strategies are implemented to reduce preventable mortality and enhance the sustainability of healthcare systems,” the researchers said.
“Future research should focus on identifying scalable, context-appropriate adherence interventions and evaluating their impact on both patient outcomes and health system costs,” they added.