Assessing and Improving Medication Adherence

by Rebecca Farley on December 14, 2011

Many provisions of the Affordable Care Act are designed to promote quality improvement and improve health outcomes. Research indicates that poor medication adherence can be an obstacle to these goals.  Patients who do not follow their medication regimens cost the U.S. healthcare system an estimated $290 billion a year, or 13% of total healthcare expenditures, according to the New England Healthcare Institute. In addition, those with low levels of medication adherence spend nearly twice as much as those who have better adherence. A new article from CNN discusses the importance of assessing and improving medication adherence, which can help alleviate the costly and dangerous problem of patients not sticking to their medication regiments.

According to the CNN article, which was authored by faculty from the Havard Medical School, government policymakers, health care providers, payers, and the pharmaceutical and the pharmacy industries alike should begin to discover innovative ways to address the adherence crisis by adopting a number of adherence strategies.

Assessing Adherence

In determining how to alleviate costs associated with poor medication adherence, the authors state that it is important to properly assess whether or not patients are taking their medication. One way to assess treatment adherence is to ask questions that are less confrontational and more probing. Rather than asking “Are you taking your medicine?” try asking “We all forget to take medications sometimes. Do you ever forget?”

Education and Psychotherapy

Patient education about illness and treatment noticeably forms the basis of any treatment plan, but in itself may not be sufficient to improve adherence to a medication regimen. However, studies have shown that providing this type of education both to families and loved ones can improve medication adherence and reduce relapses in patients.

When a patient lacks insight into the illness or is not convinced of the need for medication, cognitive behavioral therapy may help clarify how medical adherence can reduce symptoms or improve health outcomes. Combining cognitive behavioral therapy with motivational interviewing can help patients progress from thinking more positively about medication to actually taking it.

Interpersonal and social rhythm therapy, according to the authors, helps patients to resolve difficulties with other people and maintain a stable daily routine. Several studies have shown that patients who have undergone this therapy are more likely to follow medication regimens and avoid relapse.

Medication Strategies

The authors provide a number of medication strategies that can be used to promote medication adherence. The best approach depends on why the patient is having trouble adhering to a medication regimen. Symptom and side-effect monitoring may help address concerns early on, before a patient stops taking the medication. Providing a patient with a daily checklist or mood chart to bring to the next visit may give the therapist a better understanding of what might be of concern.

Using low-tech devices such as pill boxes with compartments to divide doses by days of the week can also help remind patients to take their medication.

Long-acting medications such as injectables that are effective for extended periods of time may also improve medication adherence and reduce the risk of relapse in patients. Using this strategy is best combined with psychotherapy and education so that the patient better understands the rationale behind it.

Building a Therapeutic Alliance

No matter what intervention strategy is used, research consistently demonstrates that a strong therapeutic alliance is one of the most powerful ways to encourage patients to take medication as prescribed. While building a strong alliance may take a long time, it is important to remember that as with any relationship, having mutual trust and respect is imperative in building a strong alliance.

With several provisions in the ACA intended to promote medication adherence, it is now more important than ever to begin addressing one of the most persistent problems facing our health care system. Non-adherence is extremely prevalent throughout the U.S. and beginning to adopt these adherence strategies will help to improve quality of care and lower costs.

The full text of this CNN article can be found online.

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