According to Gallup's latest annual poll on how the general American public views various professions, nurses were ranked the most honest and ethical. In fact, that's the case for the previous 16 polls as well. Gallup notes that 84% of Americans rate the honesty and ethical standards of nurses as "very high" or "high," topping physicians (67%) and pharmacists (66%), who round out the top three.
This perspective puts nurses in a terrific position to help their patients with one of the most important — and often challenging — components of achieving better health and wellness: adhering to a medication regimen.
Here are four nursing interventions that can improve medication adherence.
1. Provide Education and Resources
As a Journal of the American Medical Association article notes, "Among adults with chronic illness, 30% to 50% of medications are not taken as prescribed. In the United States, it is estimated that medication non-adherence is associated with 125,000 deaths, 10% of hospitalizations, and $100 billion in healthcare services annually."
There are numerous factors that can contribute to medication non-adherence, as noted in this diagram developed by the Massachusetts Medical Society. Nurses can help address many of them by providing their patients with targeted education and resources.
For example, one factor is "limited language proficiency." Nurses can work to ensure patients receive information about their medications (e.g., dosing schedule, instructions, side effects, refill schedule) in their preferred language. In addition, nurses can work to arrange for patients to speak with a provider in their preferred language. This will allow patients to learn about their diseases and medications in a language they can more easily understand and create an environment that encourages asking questions and sharing concerns.
Another factor is "perceived benefit of treatment." Nurses can spend time with patients explaining the importance of medication adherence and reviewing the numerous risks associated with non-adherence. If patients believe the information provided to them about adherence to be true, they are more likely to take this advice seriously.
A third factor is "medication cost." Nurses can help patients take advantage of ways to reduce the out of pocket cost of their medications. This can include purchasing generic drugs, ordering medications online, finding discount plans and coupons, and applying for federal financial assistance.
2. Encourage Honest, Open Communication
How important is communication to medication adherence? As a HealthLeaders report on research published in Circulation: Cardiovascular Quality and Outcomes 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."
Furthermore, a Million Hearts initiative pamphlet notes that two-way communication "… doubles the odds of your patients taking their medications properly."
Considering their high level of built-in trust, who better than nurses to engage in these discussions with patients? Open communication between nurses and patients can help establish a foundation for regimen and adherence success. It will also help nurses identify potential warning signs for patients who may struggle with adherence and then engage in meaningful discussions with patients about those red flags and ways to avoid them.
3. Provide Positive Reinforcement
As noted, medication adherence isn't easy for many patients, and there are many ways patients can falter in their efforts to properly follow a regimen. That's why, as the Million Hearts pamphlet notes, healthcare professionals who "provide positive reinforcement when patients take their medication successfully" can effectively modify patients' beliefs and behavior to support greater adherence.
In short, a little praise can often go a long way.
4. Help Establish a More Effective Schedule
A CVS Health poll of more than 2,000 adults who either had a chronic condition or were taking five or more prescription medications found that "… keeping to a dosing schedule is by far the most common challenge for those juggling multiple medications. 69% percent of respondents say they find this to be a challenge, and 39% say it is the most challenging part about managing their medications."
Nurses can help reduce this barrier to adherence. A BeMedWise Program report advises patients to, "Talk to your doctor or pharmacist about how you could simplify your medication schedule so it will be easy for you to keep track of everything. If possible, take your medicines at the same time each day, and tie your medication schedule to your daily activities." Nurses can advise their patients to engage in such discussions with doctors and/or pharmacists and then work with patients to help develop a more personalized, efficient medication schedule that will reduce the likelihood of missed doses and refills.