Counseling to enhance medication adherence

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Poor medication adherence is a serious problem, with a reported three out of four Americans not taking their medications as directed. Nonadherence results in numerous medication-related hospitalizations and billions in health care–related costs annually. Familiarity with and incorporation of educational methods aimed at reducing medication nonadherence are essential.

Motivational interviewing

Many pharmacists give patients advice about the importance of medication adherence by simply telling them to take their medication as directed. Patients may passively agree to take their medication regimens but not follow through. This approach to counseling patients is not effective because it fails to explore the patient’s barriers and motivations toward being adherent to the regimen and does not address the patient’s readiness to commit to following through with the prescribed plan.

Motivational interviewing is an alternative form of communication that combines a patient-centered yet directive approach to discussing medication adherence and health behavior change. Motivational interviewing focuses on the patient’s own motivation for change and adherence to treatment and identifies reasons why a patient may be ambivalent or resistant to making a change.

Motivational interviewing requires much education, training, and practice. Further information about this concept and technique is available in APhA’s communications book by Bruce Berger (Communications Skills for Pharmacists, third edition; available in print in the Shop section of pharmacist.com and online at PharmacyLibrary.com).

Understanding of disease, medications

Patients with a poor understanding of their disease and medication regimen and their personal consequences of nonadherence are more likely not to take their medications properly. Patients should be educated about the benefits of treatment and what may happen if medications are not taken as prescribed. Counseling should be tailored to address a patient’s specific diseases (e.g., a stroke may occur if blood pressure medications are missed). To enhance adherence, key points of the medication regimen should be reinforced, such as how the medication works, the proper dosage schedule and administration (e.g., show patients how to use an inhaler), what to do if doses are missed or delayed, proper storage, and common and serious adverse events.

Use the “teach back” method to assess whether patients understand what you told them. This method incorporates several steps such as explaining a new concept, assessing the patient’s recall and understanding, clarifying the explanation as needed, and reassessing comprehension until the patient has a clear understanding of the information. The following is an example of a teach-back question: “I want to be sure I explained everything clearly. Can you tell me the two main adverse effects of your new medicine?” When using this method, try to place the burden back on yourself to help the patient feel at ease.

Information should be tailored to each patient’s health literacy. Patients with low health literacy may have difficulty understanding verbal instructions or reading health information such as educational brochures or prescription labels. Pharmacists can improve adherence by simplifying information for all patients and assuming that most patients have difficulty understanding medical terminology.

Simplifying regimen, patient reminders

Trying to incorporate the dosage schedule into the patients’ schedule and lifestyle and using patient reminders are other interventions aimed at enhancing adherence. Talk to patients to determine the best time for them to take medications and find out if regimens with multiple daily doses may be problematic. Converting regimens to once-daily dosing options and reducing pill burdens by using combination tablets may be beneficial interventions for improving adherence. Patient reminder aids such as medication calendars, pill boxes, and/or telephone or mail reminders may also enhance adherence.

Addressing cost issues

Given the high cost of drugs, the issue of reimbursement and access to care should be addressed with all patients. Medication nonadherence may be a result of a patient’s inability to pay for prescribed therapies. Talk to patients about insurance coverage, access to assistance programs, and the availability of cheaper options if cost barriers influence adherence.

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