How to Assess Adherence to Medical Treatment Regimens

Posted on April 22, 2016 |

This guest post was authored by Kimberly Driscoll, Ph.D. Dr. Driscoll is licensed clinical psychologist specializing in the use of technology to improve patient adherence and is a member of the PRAXIS Advisory Board.

I have often heard family members, medical students and even providers say that patients “should just do what they need to do to manage their disease.” This is nice in theory; however, decades of research and clinical practice have shown that many patients are unable or unwilling to adhere to their treatment regimens. In fact, 30% of patients fail to adhere to short-term regimens such as antibiotics; 50% of pediatric and adult patients do not adhere to treatments for chronic conditions; and 75% of people are not able to engage in lifestyle changes (e.g., diet, exercise).

The reasons vary from volitional nonadherence (e.g., refusal, adherence holidays, avoidance of negative side effects) to unintentional adherence (e.g., forgetting, inadequate knowledge and skills). In addition, some patients are unable to adhere because of financial problems.

Importantly, one understudied and underappreciated reason for lack of adherence is patient-provider miscommunication. Some studies have demonstrated that providers recall far more information that they think they provided to patients, whereas patients recall very little, and the overlap is surprisingly low.

There are many “Do’s and Don’ts” that can be used to encourage adherence, and as you might expect, threatening patients with negative health consequences (and even death) is not one of them! Take a look at the graphic on the right; are these approaches you are using successfully with your patients? Let us know in the comments!

For those interested in learning more about adherence, please also see: Patient Adherence to Medical Treatment Regimens: Bridging the Gap Between Behavioral Science and Biomedicine (Current Perspectives in Psychology) by Alan J. Christensen.

5 Comments

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HIcopd - Hawaii State Captain

There is very little feedback given to providers on how well or poorly patients are actually doing with the meds being prescribed. For example two elderly gentlemen were NEVER taught by provider or pharmacist how to use Advair discus, but they were regularly given samples of it. Relatives and friends kept asking for something else.

One patient kept getting horrible thrush and a hoarse voice and difficulty swallowing. The other patient would just get the powdered Rx all over the place except in his lungs.

The MD for the 1st patient never tried switching the patient to the MDI "puffer" form of Advair or any other similar combo inhaler, so he never got the relief he craved, despite repeated requests.

The other patient was able to get his MD to prescribe the MDI form of Advair with a spacer and the patient's breathing had improved, as has his adherence to taking the Rx, since he can tell it is making a difference and he now rarely needs his rescue albuterol!

There really needs to be better communication between Providers and patients.
Reply
- Kimberly Driscoll
  
  I completely agree with you about everything. Part of the problem is that there aren't great ways to assess adherence to medications outside of type 1 diabetes and some other diseases in which blood levels can be assessed (e.g., epilepsy). Patient education is a must; it's necessary but not sufficient. Medical schools are starting to incorporate behavioral medicine and psychosocial training into their curriculum (and it's actually now mandated by the AAMC) and I am hopeful that our future physicians will be better trained in the area of patient-proved communication. But they also need time and unfortunately encounters can be brief and dictated by others. My best advice is to encourage all patients to not be intimidated by asking questions of their physicians. It's their right!
  Reply
HIcopd - Hawaii State Captain

Support groups and pulmonary rehab can be other excellent places to get more information and confirmation about how to get the most out of your medications. The elder who was able to get his medication changed from the Advair Discus to the MDI only got it because his child persisted in asking his MD to make the change and call it in to the pharmacy. The child also persisted in asking that the patient receive a spacer, to aid in getting more of the medication into the lungs instead of the throat and mouth.

Neither the patient NOR the healthcare provider thought of trying alternatives for the patient. Neither of them was concerned about the huge number of rescue albuterol inhalers the patient was prescribed and using.

I don't believe healthcare providers receive enough education about the different inhalers and alternatives. They also don't know which questions to ask, to learn whether or not the patient is actually benefitting from the inhalers. The appointments tend to be too rushed to have meaningful discussion about this. Patients want to be "nice" and not "get the doc upset," so just nod and smile when the doc asks how things are going instead of admitting that they don't feel the medication is helping and asking whether there is anything else they could try or a different formulation. Not all docs or patients are even aware that there are different formulations of Advair and Spiriva, and that some patients benefit from one delivery device over another.

Reply
- Jean IA State Captain
  
  The demographics for people with COPD aren't conducive to patient education and need to be taken into account when thinking about how to work with patients with COPD. Typical patients are elderly, are in the lower end of the socio-economic scale, don't have much education, are health illiterate, and generally pretty suspicious of anyone in authority. This isn't always true, of course, but many patients with COPD fall into those categories. That makes the questions the health care provider ask even more important: how did you get here today? How will you get your prescriptions? Show me how you take your prescriptions. Tell me what you ate for breakfast, lunch and dinner yesterday. Describe what you did all day yesterday.
  
  All those questions can give the provider valuable information about the patient and his/her ability to function with COPD.
  Reply
MuMarie

I feel it should be mandatory that all medicines, but especially all inhalation medicines, include the package insert that has specific information about how to use the inhaler, how to clean it, what to do if it doesn't work etc. I was amazed that there are pharmacies that just put the inhaler in a bag without the instruction section that is specifically written in simple terms for the patient. Every little bit helps......
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How to Assess Adherence to Medical Treatment Regimens

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How to Assess Adherence to Medical Treatment Regimens

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