Measuring Your Medication Adherence: A Practical Checklist
Why Medication Adherence Matters More Than You Think
If you’re taking medication for high blood pressure, diabetes, or cholesterol, skipping a dose here and there might seem harmless. But missing just 20% of your pills can cut your treatment’s effectiveness in half. That’s not a guess-it’s what studies show. The World Health Organization says more than half of people with chronic conditions don’t take their meds as prescribed. And it’s not just about feeling worse. Non-adherence costs the U.S. healthcare system $100 billion to $300 billion every year in avoidable hospital trips and emergency care.
Here’s the hard truth: doctors can’t fix what they can’t see. If you’re not telling them you missed your pills, they think the medicine isn’t working. So they might increase your dose, add another drug, or run more tests-all while the real problem is you didn’t take what you were given.
What Counts as Adherence? It’s Not Just Taking Pills
Adherence isn’t just about swallowing pills. It’s three things: initiation (did you start?), implementation (are you taking them right?), and persistence (did you keep going?).
Let’s say your doctor prescribes 30 pills for a 30-day course. You pick them up, but you only take 20. That’s poor implementation. You might’ve taken them all correctly, but stopped after 10 days because you felt better. That’s poor persistence. Or you never filled the prescription at all. That’s poor initiation.
Most tools measure implementation. But if you’re not starting or sticking with your meds, no tracker will help. That’s why a good checklist needs to cover all three.
The Best Way to Track Your Own Adherence (No Tech Needed)
You don’t need an app, a smart pill bottle, or a $50 device to know if you’re sticking to your plan. Here’s a simple, free, and proven method you can start today:
- Write down every dose-not just the name of the medicine, but the exact time and day you take it. Use a notebook, a calendar, or even sticky notes on your fridge.
- Mark each dose as taken or missed. Don’t guess. If you’re not 100% sure, mark it missed.
- At the end of each week, count how many doses you were supposed to take versus how many you actually took.
- Calculate your percentage: (Number taken ÷ Number prescribed) × 100.
- Compare to the 80% rule. If you’re at 80% or higher, you’re doing well. Below that, you’re at risk.
Example: You take a pill once a day for 7 days. You missed 2. That’s 5 taken out of 7. 5 ÷ 7 = 0.71 → 71%. That’s below 80%. Time to figure out why.
This method is called a medication diary. It’s used in clinics worldwide because it’s accurate, cheap, and tells you exactly where you’re slipping.
Why Your Pharmacy Records Don’t Tell the Whole Story
Many doctors use pharmacy refill data to check adherence. They look at your prescription history and calculate something called Proportion of Days Covered (PDC). If you filled your blood pressure meds for 24 out of 30 days in a month, they say you’re 80% adherent.
But here’s the catch: just because you picked up your pills doesn’t mean you took them.
Studies show that 32% of people say they take their meds as prescribed-but electronic monitors prove only 14% actually do. That’s a huge gap. You could be filling your prescription every month, but leaving the pills in the bottle. Or taking them only on weekends. Or crushing them because they taste bad.
Pharmacy data is useful for population studies. But for you? Your personal diary is more honest. And more helpful.
When to Use a Questionnaire (Like MARS-5)
If writing down every dose feels too much, try the Medication Adherence Report Scale (MARS-5). It’s a 5-question survey doctors use to spot hidden non-adherence.
Answer these honestly:
- I sometimes forget to take my medication.
- I sometimes stop taking my medication when I feel better.
- I sometimes skip doses because I don’t like the side effects.
- I sometimes take less than prescribed because I’m worried about costs.
- I sometimes take more than prescribed because I think it will help more.
Rate each from 1 (very often) to 5 (never).
Add up your scores. 20-25 = high adherence. 15-19 = moderate. Below 15? You’re at risk. This isn’t a test-it’s a conversation starter. Bring this to your next appointment. Say: “I scored 12. I need help.”
Common Reasons People Miss Doses (And How to Fix Them)
It’s not laziness. It’s not lack of willpower. Here’s what really happens:
- Too many pills → Use a pill organizer with days and times labeled.
- Side effects → Talk to your doctor. Don’t quit. There are often alternatives.
- Cost → Ask about generics, patient assistance programs, or 90-day supplies. Many pharmacies offer $4 generics.
- Forgetfulness → Link your pill to a daily habit: after brushing your teeth, before breakfast, when you turn off the lights.
- Confusion → Ask your pharmacist to write out a simple schedule. No jargon.
- Feeling fine → Remember: these meds are working because you take them. Stopping feels good-but it’s dangerous.
One patient in Calgary started using a pill box with alarms. She took her diabetes meds for 117 days straight. Her A1C dropped from 8.9 to 6.7. She didn’t change her diet. She just started taking her pills.
What Your Doctor Should Be Asking (But Probably Isn’t)
Most doctors don’t ask about adherence unless you bring it up. But they should. Here’s what a good conversation sounds like:
“I know taking meds every day is hard. What’s been the biggest challenge for you?”
Not: “Are you taking your pills?”
That question invites a yes. The real question opens the door. If your doctor doesn’t ask like this, ask them. Say: “I want to make sure I’m doing this right. Can we review my adherence?”
What’s New in 2025? Smart Tools Are Here-But Don’t Skip the Basics
There are now smart pill bottles that beep when you open them. Apps that text reminders. AI that predicts who’s likely to stop taking meds. Companies like AiCure and AdhereTech are raising millions to build these.
But here’s the reality: 78% of big health systems still use pharmacy refill data. Only 32% of small clinics have any system at all.
Don’t wait for tech to save you. Start with paper and honesty. If you’re tracking your doses, you’re already ahead of 80% of people.
Final Checklist: Your 5-Point Adherence Plan
- Track every dose-write it down daily. No exceptions.
- Calculate your weekly adherence rate-aim for 80% or higher.
- Use the MARS-5 if tracking feels overwhelming. Score yourself honestly.
- Identify your top barrier-cost? side effects? forgetfulness?-and fix one thing this week.
- Bring your log to your next appointment-it’s your power tool.
Medication adherence isn’t about perfection. It’s about awareness. If you know where you’re slipping, you can fix it. And that’s the only thing that matters.
How do I know if I’m taking my meds correctly?
Track every dose for one week. Write down the time and day you take each pill. Then divide the number you took by the number you were supposed to take. Multiply by 100. If the result is 80% or higher, you’re on track. Below that, you need to find out why you’re missing doses.
Is it okay to skip a dose if I feel fine?
No. Medications for chronic conditions like high blood pressure or diabetes work silently. You don’t feel them working-but if you stop, your condition can worsen quickly. Feeling fine means the medicine is doing its job. Stopping it puts you at risk.
Why do pharmacies say I’m adherent when I know I’m not?
Pharmacies track refills, not actual use. You might pick up your pills every month but leave them in the bottle. Or take them only on weekends. Pharmacy data can’t see that. Only your personal log can.
Can I use an app instead of writing things down?
Yes, but only if you use it every time. Many apps get deleted after a few days. Writing in a notebook or calendar is more reliable because it’s visible and hard to ignore. If you do use an app, make sure it logs your doses, not just sends reminders.
What if I can’t afford my meds?
Talk to your pharmacist. Many drugs have generic versions that cost $4 for a 30-day supply. You can also ask about patient assistance programs through drug manufacturers or nonprofits. Never skip doses because of cost-there are solutions, and your doctor can help you find them.
How often should I check my adherence?
Check weekly for the first month. After that, check every 3 months unless your doctor says otherwise. If you’re stable and hitting 80% or higher, you can reduce tracking. But if you’ve had recent changes in your meds or health, go back to weekly tracking.
Do I need to tell my doctor if I’m not taking my meds?
Yes. Your doctor can’t help you if they don’t know the problem. Most patients hide non-adherence out of shame. But doctors see it all the time. Being honest gives them a chance to fix the issue-switch your drug, lower the cost, adjust the schedule. Your honesty saves you from worse health problems later.
Next Steps: What to Do Right Now
Don’t wait for your next appointment. Start today.
- Grab a notebook or open a notes app.
- Write down the names of all your meds and how often you take them.
- For the next 7 days, mark each dose as taken or missed.
- At the end of the week, calculate your adherence rate.
- If it’s below 80%, pick one reason why and fix it this week.
That’s it. No fancy tools. No expensive gadgets. Just honesty and action. That’s what makes the difference.
