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Barriers to Medication Adherence in Community Oncology Practices

Jun 30, 2023

ORION by VieCure

Volume 4, Issue 6

Kristina N. Michael, APRN, WHNP-BC, Senior Clinical Associate

Identification of barriers to optimize patient health continue to be an evolving process within community oncology practices, specifically medication compliance. With a rapidly progressing older adult population, increasing numbers of medications to support chronic diseases or acute health concerns are common. This phenomenon is not unique to the United States and according to Basu et. al, “less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses” (2019). In this article, we will evaluate facility barriers versus individual barriers that providers, patients, and caregivers can identify to promote improved patient outcomes. Further research has delineated these barriers into subjective and objective categories.

The outcome of identification of these barriers is not to shift blame toward one source, but rather analyze predisposing factors that are modifiable and promote the best outcomes for patients and the healthcare system. Focusing on facility barriers to adherence involves identification at a system-wide level in addition to provider-specific care. Examples of barriers within the hospital and clinic level include but are not limited to, inadequate staffing, increased complexity of patients/higher acuity, increased patient volumes, and limited or antiquated medical record keeping vs. electronic medical record accessibility. These barriers traditionally are indirect sources of adherence, but are still critical to manage.

At the individual patient level, some barriers to adherence may include age, health illiteracy (including scheduled versus as-needed/PRN medications), lack of self-care, limited educational status, cognitive impairment, financial toxicity including insufficient insurance coverage, limited accessibility to a pharmacy/specialty pharmacy or within range for delivery address if rural, lack of caregiver or social support, in addition to fear of side effects or lack of belief in medication success. An opportunity for change lies within ancillary support staff and providers to provide thorough medication education as well as the incorporation of a teach-back protocol as the standard of care. This teach-back protocol improves disease knowledge and self-management which has a significant impact on their health behavior and outcomes.

Understanding individual barriers to care involves active discussion with the provider, patient, and/or caregiver on a consistent basis. To facilitate this need, VieCure offers an interactive patient mobile support feature which is a critical tool to improve medication adherence. This tool allows users to see medications taken, upcoming medications, new prescriptions with patient education, and a health dictionary for quick reference. As forgetfulness, complexity of care due to comorbidities, and polypharmacy within the older population is prevalent, VieCure provides reminders to take medication within the mobile application. Adherence is monitored for standard medications in addition to targeted oral therapies within the community oncology setting to facilitate patient care in community practice.

Direct communication with providers on questions and/or concerns ensures safety and consistency to avoid medication duplication, mitigate toxicities, and misuse. This functionality allows providers to address discrepancies with medication use and have an active discussion with patients to improve outcomes moving forward. Integration of the patient into their treatment plan provides opportunities for interdependence while managing their health status. The incorporation of assessments and CTCAE graded toxicities built into the platform and the patient mobile application help address potential side effects patients may experience throughout their treatment. Prompt identification of toxicities is a predisposing factor to medication compliance and has a direct impact on hospital admission rates.

Additional research on long-term implications of mobile application medication management continues. Literature supports that specifically clinician support, i.e., nursing assessments and symptom management support patients’ ability to adhere to their medication regimens (Cazeau, 2021). As technological advances continue, additional tools will need to be developed and organized to fit the needs of an aging population with multiple comorbidities. Ongoing development and analysis of the “Washburn-Barriers to Medication Adherence Screening Instrument may offer nurses a means of systematic assessment for patients at greatest risk for adherence challenges and may benefit most from mobile health interventions.” The mobile application developed by VieCure helps to bridge the disparity between patient outcomes and barrier to medication adherence.


Basu, S., Garg, S., Sharma, N., & Singh, M. M. (2019). Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings. Ci ji yi xue za zhi = Tzu-chi medical journal, 31(2), 73–80.

Cazeau N. (2021). Mobile Health Interventions: Examining Medication Adherence Outcomes Among Patients With Cancer. Clinical journal of oncology nursing, 25(4), 431–438.

Kristina Michael, APRN, WHNP-BC

Senior Clinical Associate, VieCure

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