The significance of medication adherence for patients is summarized perfectly by NEJM Catalyst: "Medication nonadherence has important health consequences, ranging from decreased quality of life and poorly managed symptoms to death." The publication also goes on to highlight the substantial financial impact: hundreds of billions of dollars in avoidable healthcare costs.
What is medication adherence? Let's review a few definitions before diving into some medication adherence best practices.
Medication Adherence Definition
U.S. Pharmacist states, "Medication adherence is the act of taking medication as prescribed by a physician. This includes consistently taking the proper dose, at the correct time, and for the recommended length of time."
Circulation states, "Medication adherence usually refers to whether patients take their medications as prescribed, as well as whether they continue to take a prescribed medication."
As Medscape notes, medication adherence is defined by the World Health Organization as "… the degree to which the person's behavior corresponds with the agreed recommendations from a healthcare provider."
Finally, Frontiers states, "Medication adherence is the process by which patients take their medication as prescribed and is an umbrella term that encompasses all aspects of medication use patterns."
Recipe for Medication Adherence Success
Keeping those definitions in mind, there are ways providers can help patients improve their medication adherence. Five medication adherence best practices are as follows:
- Understand the reasons for patient nonadherence
- Recognize polypharmacy risks
- Improve communication and collaboration
- Prioritize education
- Leverage medication reconciliation
Let's dive into each of these a bit further.
1. Understand the Reasons for Patient Nonadherence
Before providers can begin to help improve patient medication adherence effectively, they should first take the time to understand nonadherence and its contributing factors. Doing so will help providers avoid conjectures and better identify the likely causes of nonadherence.
As an American Medical Association article notes, "It is common for most physicians to assume that the most common reason for nonadherence is forgetfulness or access/cost, however this accounts for a small amount of nonadherence. Physicians are often surprised to learn that most nonadherence is intentional based on personal beliefs. Understanding the rationale behind their patient's decision to not take their medication helps the care team better prepare for conversations to steer them towards adherence."
2. Recognize Polypharmacy Risks
As we discussed in a previous blog, polypharmacy is a significant contributor to medication adherence challenges. As the number of medications used by a patient increases, as does the likelihood of achieving effective adherence. The blog identifies six ways polypharmacy — which is typically referred to when patients are taking at least five medications — creates adherence challenges. We called attention to the obstacles associated with a more complex dosing schedule, instruction confusion, side effects, reactions, elevated cost, and frequency of filling and refilling medications. Providers should be cognizant of these challenges when working to improve patient adherence.
As a U.S. Pharmacist article notes, "Poor adherence to the medication regimen is an ongoing problem among older adults. Forgetfulness, decreased vision, and poor manual dexterity may also contribute to this problem. Some patients may attribute unpleasant symptoms to a medication and decrease the dosage or even stop taking the drug without consulting the physician. Financial problems may have an effect on noncompliance."
3. Improve Communication and Collaboration
Strengthening medication adherence requires patients to feel comfortable speaking with and working closely with their providers. Any barriers to establishing such relationships are likely to stifle medication adherence improvement efforts and possibly contribute to greater nonadherence.
How important is this collaborative communication? A HealthLeaders report covering research on blood pressure medication adherence in low-income patients notes, "Researchers found that patients were three times less likely to take their high blood pressure medications when their providers did not have a collaborative communication style, such as asking open-ended questions and checking patients' understanding of medication instructions. Patients were also six times less likely to take their medications as prescribed when a healthcare provider did not ask them about social issues, such as employment, housing, and partner relationships."
One successful technique to establish good communication and collaboration with the patient is motivational interviewing (MI). MI is a patient-centered, non-confrontational communications skill set that can effectively drive patient conversations about medication issues and adherence. To learn more about motivational interviewing, read this blog post.
4. Prioritize Education
Providers who make delivering education concerning medications to their patients a high priority are likely to witness notable improvements in adherence.
Such education can speak to several medication- and adherence-related issues, such as the importance of taking specific medications and following prescriptions; risks associated with taking medications other than those prescribed and deviating from provider instructions; what to do and not do when confronted with uncomfortable side effects; and where to go for help and get questions answered. Provider educational efforts can be strengthened by recommending and giving helpful medication adherence resources to patients, which can include apps, online tools, brochures, and scripts.
A call to action made by the National Council on Patient Information and Education (NCPIE) in its report, "Enhancing Prescription Medicine Adherence: A National Action Plan," is as follows: "To motivate patients to adhere to their medication regimens, the American public must first recognize the role each person plays in taking their medications as prescribed or in making sure that a loved one does so. Simply put, the American public needs increased education about medication adherence that captures their attention, increases their understanding, and enhances their motivation to take their prescribed medication in the recommended way." This report published in 2007, and yet considerable work to improve adherence remains.
5. Leverage Medication Reconciliation
In our medication reconciliation eBook — "Medication Reconciliation: The Key Patient Safety Issue for Healthcare Providers" — we call attention to the correlation between medication reconciliation and medication adherence: "Medication reconciliation creates an opportunity to discuss adherence. Patients fail to take their medications about 50% of the time. While reasons why vary, clinicians should stress the risk factors associated with nonadherence with patients and help improve compliance with instructions."
Statistics and analyses further support the value of leveraging the medication reconciliation process as a means to improve adherence. A Patient Engagement HIT article covering the results of a survey of chief medical officers notes that 85% of respondents said more patient involvement in the medication reconciliation process could help improve access to patient medication adherence data.
Furthermore, a U.S. Pharmacist article notes that a 2016 meta-analysis that included data from 19 states and more than 15,000 patients showed that "…pharmacist-led medication-reconciliation programs had a role in decreased medication discrepancies, leading to potential benefits in adherence and other outcomes."
Finally, an article in the Annals of Long-Term Care notes, "Studies have identified medication reconciliation as the most important means of decreasing or eliminating medication discrepancies. Failure to perform medication reconciliation may leave patients and caregivers confused about the proper medications to take at home, which can lead to harmful errors."