Addressing poor medication adherence


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Detailed report available on NICE's proposals for value based assessment of health technologies

Value Based Assessment

The first stage in addressing the problem is to understand why a patient is not taking his or her medicines properly. The assessment will aim to identify the causes of poor adherence so that interventions can be tailored to the individual.

No single intervention will be applicable to all patients and most will need a combination of interventions to help them improve their adherence.

Tailoring support to an individual’s needs has the best chance of success.  Interventions may be divided into those for intentional and unintentional poor adherence. Individuals may show signs of both intentional and unintentional poor adherence and a combination of interventions is often needed.

Unintentional Poor Adherence

Unintentional poor adherence may be caused by a range of problems and any intervention needs to address the specific cause.

Forgetting to take a medicine may be a sign of confusion or it may simply be that a patient has not integrated medicine-taking into a daily routine. There are a number of interventions available to help people to remember to take their medicines. These include:

  • simple charts setting out when medicines have to taken (these can include a record sheet for patients to record when they have taken the medicine)
  • linking medicine-taking with daily events such as meal times
  • using technology to prompt medicine taking (SMS messages as reminders, electronic reminders, etc).

Intentional Poor Adherence

The first step in addressing intentional poor adherence is to understand the underlying causes such as identifying the patient’s concerns about medicines. These may be concerns about medicines in general (overuse, dependence, etc) or specific to the medicines that the patient is taking. Patients’ general concerns about medicines are likely to affect their behaviour as much as specific concerns about their prescribed medicines.

Inaccurate or incomplete information can be addressed by providing information linking the condition and the symptoms, and how the medicine addresses these. This allows patients to understand the relative risks and benefits of treatment.

Patients sceptical about the value of their treatment may need motivational counselling, using techniques similar to those used to support people to stop smoking or lose weight. Encouraging a patient to record and monitor his or her condition can provide additional evidence that the medicine is having an effect.

Side effects are often a concern for patients and having an open and honest discussion with them about side effects is important.  This may include putting side effects into the context of the benefits and long-term effects to help patients make an informed choice and discussing with patients how to cope with them. If side effects are a real barrier, it may be possible to recommend a change of medicine.

If a patient is having difficulty coming to terms with a diagnosis, it may help to put him or her in touch with a patient support group.

Conclusions

Addressing poor adherence is complex and, like all behavioural change, is likely to require repeated and tailored interventions. It can, however, make a dramatic difference to the patient’s outcome.

See http://www.pjonline.com/news/pj20110212_addressing_poor_medicines_adherence for an article on addressing poor medication adherence or  Click here to download article.

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