Improving Medication Adherence

• Medication adherence is worth paying more attention to, because when medication isn’t taken, the consequences can be dire.
• Some of the reasons patients don’t take their medication are lack of funds and mistrust of their physician. 
• One on one counseling with a nurse and daily reminders are just a few ways to improve medication adherence. 

Before I became a nurse, I was a print journalist covering health and fitness news for The Miami Herald. One of my most memorable articles was about bipolar disorder. I was inspired to write it and educate the public after two incidents occurred in my coverage area within a short period of time.

In the first incident, a man was fatally shot by federal air marshals after he allegedly made bomb threats aboard a plane in Miami. In the second incident, a man leaped from a plane’s cabin door and rushed toward an airport terminal in Fort Lauderdale. Authorities used a Taser gun to stop him, but he later had a fatal heart attack.  

Family members of both men confirmed that they had been diagnosed with bipolar disorder but had not been taking their medication. 

My goal in writing that article was to underscore the importance of medication adherence.   

At the time, I had no idea that nursing was in my future.  Now, throughout more than a decade in my second career, I have witnessed some nurses do the bare minimum when a patient refuses medication.  

By bare minimum, I mean simply clicking a button that says “patient refused” without even asking the patient why he or she refused. As patient advocates, we should work to improve medication adherence, especially when the medication is potentially a lifeline.  

What Causes Poor Medication Adherence?

Whether the medication is classified as an antipsychotic or an antiarrhythmic, we should identify the underlying causes for nonadherence and seek an intervention tailored to the individual patient. 

In a review of the literature, published in the journal Patient Preference and Adherence, the authors explained that nonadherence rates in developed countries can be as high as 50 percent, and the concept is multifaceted. According to the American Medical Association, nonadherence could be related to any of the following: 

• Fear of side effects 
• Costly prescriptions 
• Misunderstanding regarding the need for medication 
• Multiple medications and dosing schedules 
• Lack of symptoms, thus the erroneous assumption that the problem has been resolved 
• Mistrust of prescribers 
• Concerns about medication dependence 
• Apathy because of depression 

How to Improve Medication Adherence

Now that we know more about the problem of nonadherence, what can we do about it?  

According to the article in Patient Preference and Adherence, several interventions might be helpful. 

Behavioral Interventions

These include counseling, such as having a trained nurse hold a 30-minute consultation session with a patient to motivate him or her to take medication as ordered. An integral part of this intervention involves having the patient explain the ideal circumstances for medication adherence.  

 For example, a patient with multiple oral meds might be more likely to take them if he or she has a compliance kit. A patient who requires insulin might be more comfortable having a home health nurse administer the injections.

Educational Interventions

Through the provision of patient education, nurses can promote medication adherence by having patients discuss their beliefs or knowledge regarding their medication and their health. Then, the nurse can clear up any misconceptions and be forthright about the consequences of nonadherence.   

Consider the link between blood pressure medication and erectile dysfunction (ED), for example. If a patient discloses that ED is the cause of his nonadherence, the nurse can encourage the patient to be honest with his prescriber and discuss the possibility of switching to a newer beta blocker. 

Although education alone may improve knowledge, when paired with counseling or self-manage skills training, it can have a positive impact. 

Packaging and Daily Reminders

In a study of patients with asthma, one text message daily was sufficient to increase medication adherence. 

Another study compared two groups of elderly people on high blood pressure medication. One group used regular pill bottles and the other group used daily dose blister packaging. The group that used the blister packaging had higher adherence and they refilled their prescriptions more often, which led to better clinical outcomes. 

The Bottom Line

Medication adherence can significantly affect an individual’s life. Since there is no one-size-fits-all approach to improving adherence, patient engagement is crucial. Education might work for Jane, but John might need a compliance kit, counseling, and a discount app such as GoodRx. 

 While helping our patients help themselves, we should remember what former U.S. Surgeon General C. Everett Koop once said, “Drugs don’t work in patients who don’t take them.” 

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