Med Adherence Quick Guide
Medication adherence is a common problem with multiple causes and potential solutions. Use this guide to help you identify and address medication adherence issues quickly. For more information/resources pertaining to the suggestions below, see our toolbox, Medication Adherence Strategies.
- Identify patients with potential adherence issues.
- Look for patients who are at high-risk of morbidity or mortality, take high-cost medications, have chronic medical conditions, are targeted by quality measures, or are at transitions of care.
- Ask blame-free, open-ended questions to identify non-adherence, such as “It must be hard to take all your meds regularly. How often do you miss doses?”
- Consider use of a nonadherence risk assessment tool (e.g., Morisky Scale [http://www.measure
uppressuredown.com/hcprof/find/toolkit/plank4tool1.pdf]) to identify patients who would most benefit from your intervention, as well as choose the most appropriate interventions. - Examine refill information, and also watch for patients who don’t pick up their new medication in the first place.
- Help patients remember.
- Look for opportunities to reduce the number of medications the patient must take. Switch to once-daily medications or combination products when appropriate. Get rid of unnecessary medications.
- Suggest technological assistance (e.g., smartphone apps). See our chart, Medication Adherence Apps.
- Teach patients to relate taking pills to daily activities (e.g., breakfast, bedtime).
- Enlist the help of family, friends, or community services.
- Address financial or physical barriers to adherence.
- Help patients find devices (e.g., inhalers, insulin pens, etc) that suit their physical limitations.
- Suggest medication delivery for those with transportation issues. Some hospitals deliver outpatient meds to the patient before discharge.
- Look for lower cost alternatives. Be familiar with formularies to choose the most cost-effective medications.
- Help patients find free or low-cost medications. See our chart, Guide for Helping Patients Afford Their Medications.
- Communicate and educate.
- Provide educational materials in a variety of formats (e.g., written plus verbal). Use our patient handouts.
- Ask patients to repeat or “teach back” what you’ve told them to be sure they understand.
- Include the indication for the medication on prescriptions and labels when appropriate.
- Get patients involved.
- Use monitoring (e.g., blood pressure, blood sugar, peak flow, etc) to motivate and educate.
- Use shared decision making with the help of decision aids or risk calculators to get patient buy-in.
- Use motivational interviewing to help patients develop his or her own motivation and commitment to the plan.
- Explain risks, including side effects, and benefits.
- Explain benefits of adherence to the regimen and how the medication addresses the condition or prevents complications.
- Discuss side effects in the context of medication benefits. Leaflets with a list of side effects may cause anxiety. Give patients tips for management, and offer reassurance for side effects that are transient.
- Consider special populations.
- Ensure pediatric medications are palatable.
- Choose well-tolerated meds, especially for children, psychiatric disorders, and asymptomatic conditions (e.g., hypertension).