Clinicians can do a lot to keep their patients healthy. They can diagnose ailments and provide treatments. They can give advice on how to reduce the likelihood of new problems developing. They can order or refer services and recommend other providers who can help deliver effective care. They can prescribe medications to help cure a disease or condition, treat a condition, and relieve symptoms of an illness.
Unfortunately, clinicians’ abilities to help only go so far. Where that may be most apparent is with medications. Clinicians can prescribe medications but cannot fill those prescriptions and take the medications for their patients. Patients are ultimately responsible for these aspects of their care.
Fortunately, clinicians have the power — through patient medication management — to positively influence those decisions. This requires clinicians to understand obstacles to regimen adherence.
Here are four of the most common reasons patients struggle with adherence that more effective medication management can help address.
1. Low health literacy
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Statistics show that over a third of U.S. adults are likely to have difficulty with common health tasks, such as following prescription drug directions. Also, only one in 10 adults is likely to have proficient health literacy, meaning 90% of adults may lack the skills necessary to manage their health and prevent disease. This can lead to poor decisions concerning filling prescriptions and following a regimen.
Key takeaway: Clinicians must be prepared to effectively assess their patients' level of health literacy and support patients with lower health literacy through the use of communication strategies — oral, printed, and electronic — and other resources.
The top reason prescriptions are not filled? Cost, according to a Truven Health Analytics-NPR Health Poll. Concerns about cost can also motivate individuals to delay or skip refilling prescriptions, ration medications to extend the supply, and seek other, less expensive means to address their condition (e.g., purchasing medications from outside the United States, use of illicit drugs, acquiring drugs illegally). Cost is likely to remain a significant barrier to adherence. Statistics show that prescription drug expenditures account for nearly 20% of healthcare costs and prescription spending is growing faster than any other part of the healthcare sector.
Key takeaway: Cost must always be a topic covered by clinicians when discussing mediation regimens with patients. This is particularly important when changes are made to regimens that could lead to increased costs for patients. In addition, clinicians must be prepared to provide resources to help patients reduce their medication costs. Such resources can include information on how to obtain financial assistance, safely order medications by mail, and identify and use a preferred pharmacy.
While a lack of understanding about a medication could be tied to health literacy, it can also be an independent issue. There are many details about a prescription that patients may not fully understand. These include the purpose of the medication, why the medication is necessary, potential side effects (discussed further below), how long the medication should take to begin working, and rules for taking the medication (e.g., dosage, frequency, storage, risks to avoid). If patients leave an appointment without all critical information about their medications, they are more likely to deviate — intentionally or unintentionally — from the regimen.
Key takeaway: Clinicians should allocate appropriate time to discuss new medications in depth, covering all the essential details patients must know. This will help avoid questions, surprises, and feelings of doubt or confusion that could lead to mistakes or poor decisions.
Concern about potential side effects can keep patients away from the pharmacy or from sticking with a regimen if they experience unexpected side effects. Consumers are more aware of the potential for medication side effects because of prescription advertising that often includes a list of possible side effects — many of them quite severe — as part of the marketing disclaimer.
Key takeaway: Clinicians need to review the most common side effects of any new prescription with patients. Clinicians should provide guidance on what patients should and should not do if they experience side effects, both expected and unexpected. Furthermore, patients should also leave appointments with information on who they should contact if they have questions or concerns about side effects.