When a patient’s blood pressure, LDL, or A1C are not at goal and you’re tempted to escalate therapy, pause and consider if the real problem could be medication nonadherence. It’s estimated that patients do not take their medicine 50 percent of the time.1
The following tips can help your patients improve their medication adherence:
1. Ask your patients if they’re taking their medicine.
How you ask matters. Asking, “You take your medicine every day, don't you?” leaves little room for an honest answer. Instead, ask questions such as, “When you feel like your blood pressure is under control, do you sometimes stop taking your medicine?” or “Taking medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your blood pressure treatment plan?”
2. Develop a differential diagnosis of nonadherence.
Simply “forgetting” to take medication accounts for less than 30 percent of nonadherence.1 Instead, most of the time, patients decide not to take their medication for a specific reason, such as concern about a drug’s safety, side effects, or cost, or confusion about why they need to take it.
3. Tailor the solution to the problem.
For example, a patient with diabetes might stop daily insulin injections because the benefits of adherence (or the harms of nonadherence) seem too far into the future. The solution is to help the patient identify a more immediate and personal benefit, such as keeping blood glucose levels at goal to avoid having to continually update expensive eyeglasses.
4. Prescribe the fewest drugs and doses possible.
Medication adherence decreases as the number of doses per day increases, so use the fewest number of medications possible at the lowest frequency.
1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
Adapted from "Medication Adherence: We Didn’t Ask and They Didn’t Tell."
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