Of the 187 million Americans who take at least one prescription medication to treat acute or chronic illnesses, about half—93.5 million individuals—don't take their medication as prescribed.
The reasons for non-adherence are complex and highly variable. They include poor patient-provider communication, cost and access barriers, inadequate knowledge about a drug and its use, concerns about side effects, complex regimens, and simply not being convinced of the need for treatment. Moreover, adherence for a single individual may vary over time because of changes in condition, symptoms, personal circumstances, and many other factors.
Given the prevalence of non-adherence, prescribers and other care team members must assume greater responsibility for understanding and discussing potential barriers to medication adherence in order to choose treatment regimens likely to be followed. Here are two strategies providers should adopt.
1. Conduct adherence assessments to optimize medication selection
A multi-hospital health system and ACO in the northeast, for instance, uses an adherence assessment to guide medication selection for patients with elevated HbA1c levels. Embedded clinical pharmacists contact patients prior to physician office visits to administer a 10-to-12-question assessment to gauge the likelihood of medication adherence. Questions include:
- Are you taking medications currently or have you taken medications in the past?
- Have you ever missed a dose?
- How many doses have you missed in the last six months?
- Have you had any troubling side effects?
- Have you ever reached out to a doctor with concerns about your medications?
Based on the patient's responses, the pharmacist classifies patients into one of three categories:
- High adherence (7 or more responses indicate consistent adherence)
- Moderate adherence (5-7 responses indicate consistent adherence)
- Low adherence (5 or fewer responses indicate consistent adherence)
Using a patient's designated classification, the pharmacist works with prescribers to optimize medication selection. For example, the pharmacist might look into long-acting insulin products for patients with low adherence, with the goal of decreasing the number of doses and number of times a patient must take the medication. Patients in the low-adherence group might also receive follow-up phone calls on a regular basis.
2. Use patient-centered interviewing to activate patients
Boston Medical Center, addresses non-adherence through motivational interviewing and readiness assessments. The efforts aim to build provider-patient relationships, engage patients in their treatment, and proactively address potential barriers to adherence. This process enables providers to:
- Support patients in vocalizing their reasons for wanting to start or continue taking medication;
- Encourage patients to identify barriers and problem-solve independently;
- Affirm experiences of patients with a history of unsuccessful attempts at adherence–who are more likely to have low self-confidence in their ability to remain compliant; and
- Connect patients to needed support systems to preempt any adherence barriers.
For instance, a patient who feels they need more practice giving themselves injections might be directed to work with a nurse who can share tips on how to do so more easily. A patient who is worried about forgetting to take a medication might be enrolled in an automated text-messaging program.
Regardless of the specific strategy or assessment used, all organizations should consider their approach to proactively identifying common adherence barriers and tailoring interventions to reflect those concerns.
Doing something else to improve medication adherence? We'd love to hear from you, so email us at PEF@advisory.com.
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