Medication Non-adherence: Exploring the Tension Between Patient Safety and Patient Autonomy

By Seema Nayani and Bobby Gheorghiu

It may be a surprising stat to some, but roughly 30 per cent of prescriptions generated in Canada by prescribers for their patients go unfilled.1 Reasons range from prescriptions that are lost or damaged, to the cost of the medications, to forgetfulness, to not wanting to take the medication, and many others. Medication non-adherence could result in a worsening of a patient’s condition and, potentially, more frequent hospitalization and/or emergency department visits. According to a World Health Organization report, medication non-adherence accounts for five per cent of Canadian hospital admissions and five per cent of physician visits, resulting in an additional $4 billion in health care costs annually.1

Electronic prescribing using PrescribeIT™, Canada’s e-prescribing service, will enable clinicians to monitor whether prescriptions generated by prescribers are dispensed by a pharmacy. If they are not, and clinicians feel that there could be negative consequences for their patients, there is an opportunity for follow up. While such an intervention would likely result in improved adherence rates for patients, some may feel that it infringes on patients’ autonomy. A recent study of Canadians’ perceptions of e-prescribing commissioned by Infoway found that while 81 per cent of Canadians would like to receive reminders their medication is ready for pickup at their pharmacy, only 66 per cent would want their prescriber notified if their prescriptions were not filled after seven days.

A recent paper published in Healthcare Management Forum explores the tension between patient autonomy and patient safety in more detail and presents a couple of real-life scenarios that likely occur regularly across the Canadian health care system.

We’d love to hear your thoughts on finding a balance between patient autonomy and patient safety.

1 Adherence To Long-Term Therapies: Evidence For Action, World Health Organization, Geneva, Switzerland, 2003. Accessed January 4, 2018.


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About the authors
Seema Nayani

Seema Nayani

Seema Nayani is a practicing pharmacist, and continuously looks for opportunities to implement digital health solutions to improve patient care and the clinician experience. She is the Manager, Medication Services at Canada Health Infoway where she provides clinical expertise and support to a number of Infoway initiatives, including PrescribeIT®. Seema graduated from the University of Toronto, and holds certifications in Healthcare Information and Management Systems, Geriatrics and Diabetes.

Bobby Gheorghiu

Bobby Gheorghiu

Bobby Gheorghiu works with stakeholders in academia, private and public sectors to develop and monitor performance targets for initiatives such as PrescribeIT®, Canada’s national e-prescribing service, to ensure widespread adoption of technology and to demonstrate tangible benefits of investments in digital health. He holds an MHSc in Health Policy, Management, and Evaluation from the University of Toronto.