From non-adherence to adherence: Can innovative solutions resolve a longstanding problem?

Non-adherence to medication is a longstanding problem, profoundly affecting patient outcomes and sustainability of healthcare systems. Historically, non-adherence has been observed since the time of Hippocrates, however, when potent drugs became available in the midst of the 20th century, it became a pivotal concern. Despite numerous studies and interventions designed, medication adherence rates remain suboptimal, currently reaching about 50 % still, as described in WHO report two decades ago. What is worse, many healthcare professionals feel neither responsible nor able to change it. Enhancing adherence requires in-depth understanding of the concept, as many intuitive approaches fail to work. For example, contrary to expectations, patient education alone proves insufficient when addressing this issue. Both behavioural models and recent experience reflecting low acceptance of COVID-19 vaccinations strongly suggest that patients' decisions are driven by emotions, which often results in intentional non-adherence. Several technical innovations, such as smart inhalers and electronic pill dispensers, offer potential solutions. However, their effectiveness varies, and standardized certification procedures are lacking. Altogether, technical solutions do not eliminate the problem entirely. To move forward, social and health system innovation is equally needed. Multiple stakeholders could benefit from improved adherence, therefore their greater involvement is advisable to create an adherence-supporting environment. In conclusion, despite available evidence-based interventions, non-adherence remains a complex challenge. Technical and social innovations, combined with a shift in policy priorities, could lead to improved medication adherence and better patient outcomes. The global tide of non-communicable chronic conditions, and aging of societies urges us to take this problem seriously.