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Medication Adherence: Challenges, Risk Factors, and Resources
Adherence to medications may be one of the greatest challenges to public health today. Patient non-adherence is a widespread problem and physicians and healthcare providers should consider the possibility of non-adherence with every patient, at every visit. Providers may understand the impact of non-adherence in therapeutic response and remission, but they don’t feel confident in their ability to recognize and address it in their clinical practice.
Adherence is also linked to medication effectiveness. The effectiveness of a pharmacological treatment is often determined by medication efficacy, tolerability, and adherence. Adherence can be influenced by many factors including the physician, other members of the healthcare team, patients, and families. Predicting risk factors of non-adherence in patients is also challenging for clinicians. In a recent post-hoc analysis by Lindenmayer et al, they examined potential risk factors for non-adherence in patients with schizophrenia and schizoaffective disorder and found that patient characteristics such as substance abuse, baseline weight, and illness characteristics were not indicators of non-adherence.(1) In contrast, depressive symptoms or hostility were predictive for medication non-adherence.
Other common barriers related to adherence include medication costs, low health literacy, inability to follow up with patients, conflicting instructions, formularies, lack of access to medical information, lack of time, lack of electronic health records, and HIPAA.
Listed below are adherence competencies that clinicians should consider in their practice:
ASK
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Identify patient factors that may contribute to non-adherence (depressive symptoms, lack of belief in the treatment)
- Identify medication factors that may contribute to non-adherence (complex regimen, side effects, etc.)
- Ensure the patient understands the value and effect of adherence
- Determine whether the patient will be able to adhere to directions (literacy)
- Identify other medications the patient may be taking that may impact adherence and complicate adherence (complex medication regimens)
ADAPT
- Customize the regimen according to the patient’s needs (concordance)
- Provide simple, clear instructions for taking medications
- Engage family and other caregivers as needed
- Enlist ancillary healthcare providers to help the patient comply
- Identify sources of free or reduced-cost medications
- Provide patient literature in language the patient can understand
- Reinforce desirable behavior and results when appropriate
Resources are available at neuroscienceCME.com to aid in improving medication adherence in patients with mental illness: http://www.neurosciencecme.com/cme_resources.asp?ID=380
We encourage you to visit the site to take advantage of these useful resources and also view CME/CE activities that provide additional tools for clinicians to aid in addressing the challenge of medication non-adherence.
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Download printable version here.
References
1. Lindenmayer JP, et al. J Clin Psychiatry 2009;70:990-996.
This article was based in part on a toolkit developed for the use of the CME community by the University of Virginia Department of Medicine, the University of Cincinnati Center for Continuing Professional Development, Healthcare Performance Consulting, and Interstate Postgraduate Medical Association.
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