THE LAST WORD
Practical Ways to Improve Medication Adherence
Half of our patients do not take their medications, but we can change that.
Fam Pract Manag. 2016 Sep-Oct;23(5):52.
Author disclosures: no relevant financial affiliations disclosed.
Improving adherence has been a gradual process in our practice. Like most practices, we ask patients to bring all of their medications to every office visit so we can reconcile them. When we first started a program to keep patients out of the emergency department and reduce readmissions, we felt pretty smug about adding phone medication reconciliation with each patient within 48 hours of discharge. Our nurses' phone conversations with patients went something like this: “I see your furosemide was changed in the hospital from 20 mg a day to 40 mg a day. How's that going?”
Eventually we learned to ask patients “Are you taking the medications you were prescribed?” and, even better, “Do you have the medications you were prescribed?”
The problem is that patients lie about taking their medications for a variety of reasons – they do not care whether they get better, they feel fine, or they don't want their doctor to be disappointed in them. Instituting the Morisky Medication Adherence Scale3 helped, but we eventually came up with a broader set of questions:
1. Do you have all of the medications you were prescribed? (Probe for barriers such as cost or confusion.)
2. Do you understand why you are taking them?
3. Do you ever forget to take your medications? (Discuss phone alarms, putting pills by the coffeemaker, etc.)
4. Do any of your medications make you sick?
5. If you feel worse, do you stop taking them?
6. If you feel better, do you stop taking them?
7. If you have asthma, do you have a spacer? Do you carry a rescue inhaler (at work, in the car, at school, etc.)?
A nurse or medical assistant asks these questions, along with questions about health confidence, prior to the patient being seen by the provider. We record the answers in our electric health record
1. Adherence to Long-term Therapies: Evidence for Action. Geneva: World Health Organization; 2003.
2. Costa E, Giardini A, Savin M, et al. Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence. 2015;9:1303–1314.
3. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348–354.
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