Approximately 50% of patients do not take medications as prescribed. We’re talking about a whole lot of patients whose health could be unnecessarily compromised because they don’t follow instructions for the timing, dosage, and frequency of their medications.
Unfortunately, when it comes to improving patient compliance with medication, there is no ‘one-size-fits-all’ solution. Every patient is different, and every circumstance is different. This means solutions to address what some have termed the ‘sixth vital sign’ must be different as well. Identifying the underlying causes of patient noncompliance can help providers determine the appropriate intervention strategy for each of their patients.
For example, one patient may have dementia, causing forgetfulness. Another may not be able to afford their medication. Another may be symptom-free and thus stop taking their medication altogether. Providers need to dig deeply into these and other barriers and identify the patient’s specific barriers to medication compliance. The payoff can be significant. Not only do patients who take their medications achieve better outcomes and a higher quality of life, but healthcare organizations may see fewer readmissions as well. Medication adherence (or lack thereof) is often a predictor of 30-day hospital readmissions, according to a recent study published in Patient Preference and Adherence. The study found that patients with low or intermediate adherence had a 20 percent readmission rate as compared to approximately 9% for patients with high adherence.
Providers addressing barriers to medication compliance may also see lower costs. A recent study conducted by Express Scripts found that people who were non-adherent to their oral diabetes medications had four percent higher total healthcare costs compared to those who were adherent.
The following are ten strategies that providers can use to boost medication compliance.
1. Understand each patient’s medication-taking behaviors
Ask patients whether they have trouble filling, taking, or affording their medications. For example, ask: ‘Of the medications prescribed to you, which ones are you taking?’ or ‘I know it must be difficult to take all of your medications regularly. How often do you miss taking them?’ Create a blame-free environment so patients feel comfortable speaking openly and honestly. Providers can’t help their patients if they don’t know there’s a problem.
2. Talk about side effects
Patients who encounter side effects are less likely to stop taking the medication when they know about the potential side effects in advance. Providers should talk about these side effects and explain how to prevent an adverse drug reaction. What is the likelihood of those side effects, do they typically resolve without intervention, and how will the treatment plan change if they don’t resolve? Ask patients to repeat back the most important points and empower patients to ask questions.
3. Write it down
Many patients don’t retain verbal instructions, which is why it’s important to write information down. For example, provide medication calendars, pill cards, schedules, or charts that specify when and how to take medications.
4. Collaborate with patients
What time of the day would be best for the patient to take their medications? If the medication doesn’t come with specific instructions (i.e., take one pill in the morning), then brainstorm ideas with the patient. Ideally, it would be a time when the patient knows they will generally be free from other commitments and distractions. For example, if mornings are chaotic in terms of dropping children off at daycare, perhaps nighttime would be a better option, so they don’t forget.
5. Consider the financial burden to the patient
If patients can’t afford their medications, they may simply stop taking them, or they may ration them. To combat this, providers can connect patients with pharmaceutical company–based assistance plans, state-based assistance plans, and pharmacies that provide 30-day supplies of widely prescribed medications. Some EHRs also include formulary information that helps providers determine whether certain medications are covered based on the patient’s insurance. Prescribing lower-cost generic medications is also helpful.
6. Assess health literacy
Health literacy, the degree to which individuals are able to obtain, process, and understand basic health information and services, is a social determinant of health that can greatly affect patient compliance with medication. Use this AHRQ tool to assess health literacy and determine appropriate interventions, so patients understand when, how, and why to take their medications. Providers should not assume that patients understand.
7. Reduce complexity
Reducing the complexity of the drug regimen increases the likelihood that patients will follow through with taking medications correctly. Providing combination products, for example, is one way to do this. Another is to prescribe medications with once-daily dosing instead of multiple doses per day.
8. Follow up with patients
Send medication reminders via text, email, or direct mail or during time allotted for chronic care management services. Also, schedule follow-up appointments to discuss medication compliance. Don’t let patients fall through the cracks. Make sure they understand why they need to take their medication as prescribed even when they’re symptom-free.
9. Engage community pharmacists
Pharmacists are able to not only provide patient education and help patients navigate low-cost or even free medications— but they can also remind physicians to contact their patients who do not refill their prescriptions, helping providers address compliance problems before they spiral out of control.
10. Use technology
For example, e-pill medication devices (e.g., automatic pill dispensers, pillboxes and timers, and alarm watches) can help improve patient medication compliance. A Bluetooth pillbox can even send providers a remote monitoring message each time the patient opens the pillbox. This provides physicians information they can use to detect adherence issues.
These strategies can help providers help their patients comply with medication regimens. Barriers to medication compliance will always exist—what matters is how providers address them using a variety of methods.
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