Foolproof Ways to Improve Medication Adherence

Until you understand the reasons why patients aren’t taking their medications, you can’t implement strategies to improve adherence.

By Medecision

Medication nonadherence is a very real, very serious ongoing problem.

Some sobering statistics to contemplate:

• Approximately 40-50% of adults with a chronic healthcare condition don’t adhere to their medications that are supposed to help them manage their condition, according to a 2018 article in The Permanente.
• Non-adherence to prescribed medication costs at least 100,000 lives–and possibly as many as 125,000 lives–each year in the U.S.
• Non-adherence also results in $100 billion in annual costs.

The challenge is clear: how can healthcare professionals persuade more people to be compliant with their medication regimens?

Uncover the Reasons That Patients Aren’t Taking Their Medications

You can’t design strategies for improvement without knowing why people aren’t taking their medications as prescribed. So you must gain a better understanding of the most common impediments to medication compliance and identify which ones affect your patients.

According to the American Medical Association, these are some of the most common reasons that patients don’t take their medications:

• Cost. Some patients can’t afford their medications, so they don’t even get their prescriptions filled—or they ration their meds so they “last longer.”
• Too many medications. It’s hard for some people to keep up with multiple drugs, especially if they all have different dosing instructions.
• Misunderstanding. Patients don’t fully grasp why they need to take their medication—and to take it exactly as prescribed.
• Lack of symptoms. A patient who doesn’t feel noticeably different after taking a particular medication might not feel compelled to keep taking it.
• Fear. Some patients are afraid of side effects from their meds.
• Lack of trust. Some patients are suspicious of healthcare providers’ motives, as well as pharmaceutical companies and their products.
• Anxiety. Some patients worry they’ll become dependent on medication, so they address that worry by not taking it (or not taking it enough).
• Depression. Depression can get in the way of a person’s best intentions.

Knowing about patients’ concerns is a great first step. Then it’s time to decide what to do to solve this problem and help patients become compliant.

Encourage Good Patient-Physician Relationships to Improve Medication Adherence

A good patient-physician relationship is crucial. Patients who trust their healthcare provider and have a good open line of communication with them may be more likely to talk about their medication concerns—and may be more amenable to making some positive changes.

Start by urging providers to talk to their patients, to let their patients know that they want to understand their perspectives better so they can help them. Encourage them to:

• Ask patients how they feel about the status of their health overall
• Ask what concerns they may have about their medications
• Acknowledge cultural beliefs that may play a role in non-adherence
• Maintain what one expert has called a “blame-free environment” so patients feel more comfortable disclosing their fears or even admitting their nonadherence.

This can all help uncover the specific factors that are driving their nonadherence.

Delve Into Social Determinants of Health

Often, medical nonadherence can be traced back to factors in a person’s life that might not be apparent to an outsider who doesn’t know them well.

For example, a patient who doesn’t refill an important medication a month after being discharged from the hospital may not have reliable transportation to a pharmacy. With that information, a staff member could investigate specific solutions to the problem—perhaps connecting that patient with a mail-order or online pharmacy or arranging for them to get a 90-day prescription of a medication they need to take regularly.

Sometimes this type of information is captured in a patient’s electronic medical record. If your organization doesn’t already have a system in place to capture details about social determinants of health that may be affecting a patient’s progress, including their compliance with medications, it may be time to address that.

Tailor Your Other Strategies to Meet Specific Needs

Different patients will respond to different strategies—and they may benefit from a multipronged approach, since multiple concerns may be affecting their medication adherence.

Here are a few ways that your organization can address the specific kinds of concerns that your patients may have:

• Provide live support. Does your organization have a helpline that patients can call and speak to a nurse or other trained professional about their medications? Having a person who can reassure them about side effects and other issues could make the difference for some patients.
• Help patients develop personalized medication schedules. If a patient is struggling with taking multiple medications, a nurse or care manager can work with the patient to develop a personalized schedule that takes the guesswork out.
• Provide accessible educational materials. Research suggests that low health literacy is a major barrier for many people who struggle with medication adherence. Instructions that make sense to a doctor, pharmacist or nurse can seem impossible to understand to these patients, so they give up. Providing easy-to-understand educational materials can address this problem.
• Address the cost factor. If cost is a big concern for some of your patients, you might invest resources in this area. Designate a staff person who can help them figure out where to get their medications at the best cost. Patients may not know about online pharmacies, patient assistance programs or discounts that would make it easier for them to afford their meds.
• Encourage the use of technology. Some patients may be more amenable than others to using technology. Encourage the ones who are interested to use reminder apps on their devices to alert them when it’s time to take their medication.

Start by uncovering the reasons patients aren’t taking medications, then tailor your strategies to specifically address those concerns. Ultimately, your patients will be healthier with better medication adherence, and that can also save everyone valuable dollars.