Intuitively I asked this question since my long study of adverse drug events (ADEs) has shown that taking more medications or increasing the “drug burden” is the strongest predictor or risk factor for experiencing an ADE. (An ADE can be defined as harm from a medication- that simple) Therefore, it made sense if people are poor adherers to their medications that they may be more likely to experience an ADE after improving adherence. This is most concerning when being admitted to a hospital or nursing home for rehabilitation because 100% adherence is just about guaranteed!
I found good evidence of this concept in the HIV/AIDS literature, where adherence is critical to success. As adherence improved, ADEs went up. I also talked to some front-line HCPs that also evaluated community-based adherence upon admission to the hospital since they too wanted to know of the person was at risk for an ADE. If poor adherence was detected then a change in dosing might be appropriate to mitigate that risk. Yet another study The Burden and Risk Factors for Adverse Drug Events in Older Patients www.ajol.info/index.php/samj/article/download/13853/59661 showed that those older adults who were more compliant with taking their medications were more likely to experience a ADE (p=0.02). Noteworthy, is that some studies that set out to improve adherence supposedly measure the impact of improving adherence on the risk for ADEs, but I’m not convinced they look all that hard or know where to look. Regardless, this is a critical concept to be aware of since if it holds true over time with more rigorous studies, we’ll have to change our approach to improving adherence, especially during care transitions in order to “first do no harm”.