The most important thing we can do as practitioners is to remember that non-adherence is a prevalent problem and to ask our patients if and how they are taking their medications. If answers are discordant from available pharmacy data, one needs to address the discrepancy.
It’s easy in clinic visits to focus on side effects and disease control, but asking more open-ended questions, such as, “Do you have any concerns about your medications?” or “What might get in the way of you taking this medication?” might give a patient space to share whatever problem they are having.
A shift in physician mentality from non-adherence to shared decision making can be helpful in improving adherence to medication and improving disease control.
Jennifer Stichman, MD, is an assistant professor of general internal medicine at Denver Health and the University of Colorado.
Dennis J. Boyle, MD, is an associate professor of medicine and rheumatology at Denver Health and the University of Colorado.
Highlights & Tips
- Medications only work when taken.
- Rates of non-adherence are much higher than we think.
- Non-adherence is associated with poor outcomes.
- Non-adherence is an issue for patients from any socioeconomic background.
- Ask patients in an open fashion how they take their medicines.
- Do anticipatory problem solving around medications.
- Explore patient worries and concerns about medications.
- Use the teach-back method.
- Write or print a med list at the end of every visit.
- Enlisting the patient in their care is as important as making the correct diagnosis.
References
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- Grijalva CG, Chung CP, Arbogast PG, et al. Assessment of adherence to and persistence on disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis. Med Care. 2007;45(10 Suppl 2):S66–S76.
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- Kleinman NL, Brook RA, Patel PA, et al. The impact of gout on work absence and productivity. Value Health. 2007 Jul–Aug;10(4):231–237.
- van Hulst LT, Kievit W, van Bommel R, et al. Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: Results of a maximum difference scaling experiment. Arthritis Care Res (Hoboken). 2011 Oct;63(10):1407–1414.
- Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011.
