The unsolved mystery of patient adherence

28th May, 2025 • by Mauro Morando
The unsolved mystery of patient adherence

We have just wrapped up two fascinating projects - one in osteoporosis, the other in type 2 diabetes. Both are perfect examples of 'silent diseases': conditions that often progress unnoticed until substantial, sometimes irreversible, damage has occurred. Yet, despite the differences between these therapeutic areas, both led us back to the same deceptively simple, and consistently elusive question: 'Are patients really taking their medications?'

 

When you ask patients, the answer is usually enthusiastic: “Yes, of course. I take it every day. It’s part of my routine.” Ask healthcare professionals, and you’ll hear something very different: “They stop after a few months.” “They only take it when they feel symptoms.” “It’s one of the biggest challenges in managing treatment long-term.”

 

This disconnect is not just a one-off. It points to a bigger problem in how we manage chronic diseases.

 

Why is adherence still an issue?

 

Despite decades of focus, non-adherence remains one of the most stubborn barriers to successful treatment. We often treat it as a matter of compliance, discipline, or awareness, but the reality is far more complex.

Patients don’t stop taking their medication because they’re careless or disinterested. They stop for a variety of deeply human, often overlapping reasons.

 

Some simply forget, especially when juggling multiple prescriptions and daily responsibilities. Others feel better after a few weeks or months and assume the treatment has done its job. Some face financial barriers or find themselves navigating inconsistent pharmacy supplies or limited insurance coverage. And then there is fatigue: patients who silently disengage because they are overwhelmed, burned out, or unsure whether the medication is truly helping.

 

We also see issues that are less visible but just as impactful: a lack of social support, underlying mental health challenges, missed appointments, or prior negative experiences with healthcare professionals. In each case, the result is the same: treatment is paused, adjusted, or abandoned.

 

The adherence paradox in “Invisible” conditions

 

In our osteoporosis research, the pattern was familiar. Patients often equated no pain with no problem. Some openly admitted they took their medication “only when they remembered”, not because they were rebelling against medical advice, but because the consequences didn’t feel urgent.

 

In our diabetes study, a similar logic applied. Patients who saw stable readings began to relax. Some stopped checking their blood sugar altogether. “I know how my body feels,” one said, confident that intuition could replace measurement. But this often leads patients to adjust their insulin doses based on feeling rather than data, which can be risky.

 

In both cases, the underlying story was the same: patients were not lying. They genuinely believed they were doing enough.

 

A widespread challenge across therapeutic areas

 

These are not certainly isolated stories. They reflect a much broader trend across healthcare, particularly in conditions where symptoms are absent or intermittent.

 

• In hypertension, only around 51% of patients remain adherent to long-term treatment [EMC, 2023 – https://www.emc.id/en/care-plus/must-know-beware-of-asymptomatic-hypertension-and-how-to-treat-it].

 

• In asthma, adherence to inhaled therapies often falls below 50%, driven by technique difficulties, regimen complexity, or denial of the condition [PMC, 2011 – https://pmc.ncbi.nlm.nih.gov/3191684/].

 

• In mental health, adherence rates are among the lowest: 56% for schizophrenia, 50% for major depressive disorder, and just 44% for bipolar disorder [PMC, 2017 – https://pmc.ncbi.nlm.nih.gov/5418936/].

 

In contrast, when the stakes feel immediate, the pattern shifts:

 

• In HIV, adherence to antiretroviral therapy (ART) remains a challenge but rates average around 70–80% globally [WHO, 2023 – https://www.who.int/news-room/fact-sheets/detail/hiv-aids].

 

• In multiple sclerosis, one study showed 77.2% adherence at one year - which is far better than adherence seen in conditions like rheumatoid arthritis, epilepsy, or Parkinson’s disease [AJMC, 2021 – https://www.ajmc.com/view/comparison-of-adherence-across-chronic-conditions].

 

Urgency, visibility, and structured support systems make a measurable difference.

 

Supporting adherence - what works and what doesn’t

 

We often get involved with helping pharmaceutical companies finding good solutions to support patient adherence and we have heard all sorts of feedback. Digital tools, apps, reminders, and smart pillboxes can ease the burden of remembering. Motivational interviewing where HCPs shift from instructing to exploring beliefs opens space for honest dialogue. Peer stories resonate in a way clinical facts rarely do. And simplifying regimens—through weekly dosing, fixed-dose combinations, or home delivery can reduce friction.

 

As AI continues to reshape healthcare, adherence is becoming a prime target for automation and optimization. Predictive algorithms, chatbot reminders, and even AI-generated nudges promise better outcomes at scale. These tools can help flag patients at risk of dropping off and optimize when and how reminders are delivered.

 

Also, behavioral science is also making a resurgence, this time with a digital twist. There’s growing momentum around personalized nudging, adaptive messaging, and gamified self-management, rooted in behavioral models and patient segmentation. When done well, these approaches can create more relevant, timely, and psychologically informed touch-points.

 

On the other hand, let’s be honest: many traditional efforts may still fall flat according to the feedback we receive from both physicians and patients. Educational materials often feel generic. Scare tactics may prompt action but not for long. And subtle blame, even unintended, may push patients away rather than pulling them closer.

 

So where do we go from here?

 

We need to stop treating adherence as a binary outcome and start recognizing it as a complex behavior influenced by belief, context, and experience.

 

Let’s move from asking “Are patients adherent?” to asking a different set of questions: “Do they believe in the treatment?” “Do they feel the benefits - or only the burden?” “Does the treatment regimen fit their life - or complicate it?"

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Privacy Policy

INTRODUCTION
Your privacy is important to us, so through this document, we will explain what data we collect from our users, how we use it, and why, among other guidelines.
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DATA CONTROLLER
Identity: PIP HEALTHCARE, S.L. (also, the provider)
Tax identification number (NIF): B56851223
Registered address: World Trade Center - Muelle de Barcelona Edificio Sur, 2ª Planta, 08039, Barcelona
Email: [email protected]

PIP HEALTHCARE, S.L., as the owner of the website, in accordance with Regulation (EU) 2016/679 of 27 April 2016 (GDPR) on the protection of individuals with regard to the processing of personal data and on the free movement of such data and other existing regulations on the protection of personal data and by Law 34/2002, of 11 July, on Information Society Services and Electronic Commerce (LSSICE), informs you that it has implemented the necessary security measures, both technical and organizational, to ensure and protect the confidentiality, integrity, and availability of the data entered.

DATA COLLECTION METHODS, DATA THAT WE COLLECT and PURPOSE OF DATA PROCESSING:

The data we collect and the methods we use to obtain it are as follows:
1. To carry out the commercial, administrative, fiscal, and accounting procedures that are required under current legislation.
• Required data: name, surname, phone number, location, ID, email, signature.
• Purpose: to carry out the internal commercial, administrative, fiscal documentation.
• Legitimization: consent of the data subject.
2. To manage recruitment processes
• Required data: name, surname, email, CV, and any other information the User voluntarily shares.
• Purpose: to carry out the management of selection processes.
• Legitimization: consent of the data subject and contractual relationship.
3. Conduct research interviews or online questionnaires.
• Required data: name, phone number, professional information, voice, image, any information the participant voluntarily shares during the interviews or in the questionnaires (e.g.: age, gender, location, health data, etc.).
• Purpose: to conduct research (interviews and/or questionnaires).
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According to the LSSICE, PIP HEALTHCARE, S.L. does not engage in spamming and, therefore, does not send commercial emails that have not been previously requested or authorized by the user. Accordingly, in all the communications you will receive from the provider, the user has the possibility to withdraw their express consent to receive our communications.
We will not process your personal data for any purpose other than those described except for legal obligation or judicial requirement.
You will not be the subject of decisions based on automated processing.

DATA RETENTION PERIOD
Your data will be retained for the duration of your commercial relationship with us or until you exercise your right to the cancellation, withdrawal, or limitation of processing. However, we will retain your data for the time required by law in accordance with the applicable provisions.

RECIPIENTS OF DISCLOSURES AND TRANSFERS
PIP HEALTHCARE, S.L. will only provide information to law enforcement agencies under a court order or legal obligation, without prejudice to the ability to block or cancel your account if there are any indications that the user has committed any crime. The information provided will only be available to the provider at that time.
The information that you provide us through this website will be hosted on the PIP HEALTHCARE, S.L. servers, contracted from the company that provides the web hosting service. The processing of the data of the entity is regulated by a data processor contract between the provider and this company.
In addition, the provider uses certain tools to provide the services necessary for the development of its activity, which are able to store your data. These tools are as follows:
Google Analytics: to perform analysis and take measurements of the use that users make of the website through cookies. The information generated and collected by these cookies on use (including IP addresses) will be directly transmitted and archived by Google Inc., a Delaware company located at 1600 Amphitheatre Parkway, Mountain View (California), CA 94043, USA (“Google”), on their servers in the United States.
Email marketing: used for mail marketing service Mailchimp, The Rocket Science Group Llc., located in the U.S., and subscribed to the Data Privacy Framework EU – U.S.
Software used to transcribe the interviews: Otter.ai, Inc. located in the U.S. and subscribed to the Data Privacy Framework EU – U.S.; and Sonix, Inc., located in the U.S., which relies on standard contractual clauses.
Software used to conduct online meetings: Zoom Voice Communications, Inc., located in the U.S., and subscribed to the Data Privacy Framework EU – U.S.
THE RIGHTS OF THE INTERESTED PARTIES
As a user/interested party, you can request to exercise the following rights before PIP HEALTHCARE, S.L. by sending a letter to the postal address in the header or by sending an email to [email protected], with the subject, “DATA PROTECTION: RIGHTS OF THE AFFECTED”.

Rights
• Right of access: allows the interested party to know and obtain information about their personal data subject to processing.
• Right to rectification: allows the interested party to correct errors and modify data that is inaccurate or incomplete.
• Right to erasure/to be forgotten: allows inadequate or excessive data to be deleted.
• Right to object: the right of the interested party to not have their data processed or to stop the processing of the same.
• Right to restrict processing: involves the flagging of stored personal data in order to limit any future processing, for the exercise or defense of claims.
• Right to data portability: involves the disclosure of the data undergoing processing to the interested party, so that they can transfer it to another controller without any impediments.
• Right not to be subject to a decision based solely on automated processing, including profiling: the right not to be subject to any decision that is solely based on automated processing that effects or will significantly affect the interested party.
As a user, you have the right to withdraw the consent given at any time. The withdrawal of consent shall not affect the legality of the processing performed prior to your consent being revoked.
You also have the right to lodge a complaint with the supervisory authority if you believe that your rights in relation to the protection of your data may have been infringed (aepd.es).

ADDITIONAL INFORMATION
SECURITY MEASURES
The data you provide to us will be treated confidentially. The provider has adopted all the technical and organisational measures and all the levels of protection necessary to ensure the secure processing of data and to prevent its alteration, loss, theft, and unauthorised processing or access, in line with the current state of technology and the nature of the data stored. Likewise, it guarantees that the processing and registration in files, programs, systems, equipment, premises, and centres comply with the requirements and conditions of integrity and security established in the current regulations.

LANGUAGE
The applicable language for this Privacy Policy is Spanish. Consequently, in the event of any contradiction between the versions provided in other languages, the Spanish version will prevail.

SOCIAL NETWORKS
PIP HEALTHCARE, S.L. can have a presence on social media. The data processing carried out on people who become followers (and/or perform any linking or connecting action through social networks) of the official pages for PIP HEALTHCARE, S.L. on social networks will be governed by this section as well as by the conditions of use, privacy policies, and access regulations of the social network that is appropriate in each case and previously accepted by the user.
PIP HEALTHCARE, S.L. will process your data for the purpose of correctly managing its presence on the social network, informing you of activities, products, or services from the provider as well as for any other purpose that the regulations of the social network allow.
It is forbidden to publish any content:
- That is presumed to be illegal under national, community, or international law or that engages in activities that are presumed to be illegal or that contravene the principles of good faith.
- That violates the fundamental rights of individuals, does not show courtesy on the network, upsets or can generate negative opinions in our users or third parties and, in general, any content that PIP HEALTHCARE, S.L. considers inappropriate.
- And, in general, that contravenes the principles of legality, honesty, responsibility, protection of human dignity, protection of minors, protection of public order, privacy protection, the protection of the consumer, intellectual, and industrial property rights.
Likewise, PIP HEALTHCARE, S.L. reserves the right to remove any content that is considered inappropriate without previous notice from the website or the corporate social network.
In any case, if you submit personal information through the social network, PIP HEALTHCARE, S.L. will be exempt from any liability in relation to the security measures applicable to this platform and to the user. If you want to know what these are, you should consult the specific terms of the network in question.

CHANGES TO THIS PRIVACY POLICY
PIP HEALTHCARE, S.L. reserves the right to modify this policy to adapt it to new legislation or jurisprudence.

REVOCABILITY
The consent given, both for the processing and for the transfer of the data of the interested parties, can be withdrawn at any time by communicating with PIP HEALTHCARE, S.L. according to the terms established in this policy for the exercising of rights. This revocation shall in no case be retroactive.

LEGISLATION
In general, the relations between PIP HEALTHCARE, S.L. with the users of its telematic services, present on this website, are subject to the Spanish legislation and jurisdiction. The parties will expressly submit themselves to the Courts and Tribunals of Barcelona for the resolution of all disputes arising out of or relating to its use.