To determine whether an organization's efforts to assist patients with medication management were successful, examine one performance measure: adherence. If patients failed to adhere to their regimen, medication management efforts, one could argue, failed.
Let's look at how the Reducing Avoidable Readmissions Effectively (RARE) Campaign discusses medication management: "Hospitals working on this topic will focus on improving the use of medications for the patient's condition and ensuring that the patient understands the purpose of the medications and is taking them in the correct manner at the correct time."
While those first two components of medication management — "improving the use of medications for the patient's condition and ensuring that the patient understands the purpose of the medications" are critical, they essentially become irrelevant if patients do not take their medications properly. The takeaway: If there's no medication adherence, there is no medication management.
To put your clinicians in a better position to help patients improve adherence, follow these tips.
1. Provide education and training on adherence
Adherence is a very complex issue. An American Medical Association article notes that "Data show about one-quarter of new prescriptions are never filled, and patients do not take their medications about 50 percent of the time." Estimates of medication non-adherence rates typically range from 30% to 60%, according to a Medscape article.
Such non-adherence can be deliberate, where patients choose not to follow the prescribed medication regimen by altering the dose, timing, or frequency of the therapy. An NPR-Truven Health Analytics Health Poll noted that reasons why patients stopped taking a medication without consulting with a doctor include cost, side effects, belief that they no longer needed the drug, and belief that the medication wasn't working. Non-adherence can also be non-deliberate, such as forgetting to fill or take a medication or a lack of understanding about how to properly take a medication.
Identifying patients likely to be non-adherent isn't as simple as asking patients if they will follow their regimen. Few, if any, will admit plans to do otherwise. Rather, it will usually at least require engaging in a personalized conversation with patients and asking open-ended questions, including those that can help identify potential obstacles.
Clinicians should receive education and training about adherence. They would cover issues including the following:
- causes of non-adherence;
- how to properly — in a blame-free manner — discuss and provide education and counseling on medications and adherence;
- how to effectively ask questions;
- how to spot indicators of non-adherence or potential non-adherence;
- what solutions to offer patients to assist with adherence; and
- how to effectively engage patients so they are more likely to use the solutions.
2. Give resources to support efforts
As noted, clinicians should offer solutions to help patients adhere to their regimen. Organizations should provide their clinicians with resources that can help ensure the solutions suggested take hold.
For example, a clinician may recommend that a patient use a pill organizer to help with following a medication schedule. This advice will be more effective if the clinician has examples of organizers to show the patient how the tool works and help the patient choose an organizer that would be best for their specific needs.
As another example, if a clinician believes the use of a medication adherence app would be an appropriate means of helping support adherence, the clinician could have access to a smartphone or tablet with several examples of apps pre-loaded. The clinician could then review the options with the patient and work together to identify the app that the patient would be most comfortable using.
3. Allocate time
Clinicians are under great pressure to improve their patient throughput. The faster patients can be moved onto the next stage in their treatment, the more patients can be seen and treated. But faster throughput has the potential for critical processes to be rush, skipped, or forgotten.
Organizations must allocate enough time for clinicians to not only inquire about medication adherence, but also be able to act on what they learn or suspect. Organizations should develop a routine process for clinicians to ask about medication adherence and mandate that this process be completed during patient encounters.
4. Require documentation of adherence discussions
Organizations can take their efforts to ensure adherence is discussed one step further by requiring clinicians to document that such discussions occurred. Documentation should also include any findings, even if those findings indicate that patients are likely to adhere to their regimen.
5. Invest in assistance
Organizations must recognize the limitations faced by their clinicians. Even clinicians who perform exceptionally well in supporting their patients' efforts to follow a regimen will still have patients who are non-adherent.
Knowing this to be true, organizations should pursue other means of helping improve patient adherence. For example, mHealthIntelligence reported on health systems in Massachusetts and North Carolina that launched remote patient monitoring programs that use telehealth to monitor medication adherence in those patients identified as high-acuity and high-cost. Organizations can also invest in programs like Cureatr's Meds 360° which helps identify and address patient behaviors that indicate a likelihood on non-adherence.
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