Detecting poor adherence


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

Value Based Assessment
Identifying when patients are failing to take their medicines properly is not an exact science. It is often based on putting together a number of clues and on developing a relationship of trust with a patient such that he or she feels able to confide in their healthcare professional.

The most effective techniques for assessing poor adherence are asking specific questions about adherence in a non-judgemental way and actively listening to patients’ concerns. Experts suggest that healthcare professionals can make it easier for patients to report poor adherence by asking them if they have missed any doses of medicine recently and:

  • Asking the question in a way that does not apportion blame
  • Explaining why you are asking the question
  • Mentioning a specific period such as “in the past week”’
  • Asking about medicine-taking behaviours, such as reducing the dose and stopping or starting medicines

If patients are not taking their medicines properly, healthcare professionals should ask them whether this is because of beliefs, concerns or problems about the medicines (intentional non-adherence) or because of practical problems (unintentional non-adherence).

This enables interventions to be tailored to the cause. Poor adherence may be due to a combination of factors, eg, forgetfulness may be compounded by an underlying lack of confidence in the treatment or the presence of unpleasant side effects. The assessment should be recorded along with the reasons for the conclusions for future reference.

See for an article discussing the indicators of poor adherence and how it can be detected in day-to-day practice or Click here to download article

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