providers

Improving Medication Adherence for Better Outcomes

Patients who take at least 80 percent of their medication as prescribed are medication adherent. Patients who take less than 80 percent of their medication as prescribed are considered medication nonadherent. Medication nonadherence is common: patients don't take their medicine as prescribed about half the time. If a patient's condition is not under control, medication nonadherence may be the reason why.

The importance of medication adherence

Increasing medication adherence improves patient outcomes and reduces costs. Conversely, medication nonadherence often leads to problems for patients and providers, including:

  • Unnecessary hospitalization and emergency room (ER) visits.
  • Needless escalation of therapy. 
  • Increased costs to the patient and health care system.
  • Potential harm to the patient. 
  • Added work for providers during the visit. 

How to identify medication adherence

Many patients are reluctant to tell their healthcare provider that they do not take their medications as prescribed due to:

  • Feelings of shame or mistrust. 
  • Not fully understanding the medical diagnosis and need for treatment.
  • An inability to obtain medication due to cost, scarcity or lack of time. 

You can overcome these barriers by creating a shame- and blame-free environment to discuss medication nonadherence issues with patients. For instance: 

Conduct a “brown bag” review.

Before the patient’s appointment:

Ask them to bring in all their medications (including those that are discontinued or prescribed by other providers, as well as any supplements they take). 

During the review:

  • Ask patients about their medication use. Open up the conversation by asking a simple question: “How often do you miss taking your medications?” This framing is nonconfrontational and nonjudgmental, and it normalizes the problem. It also creates space to discuss barriers to adherence and develop personalized solutions with your patient.   
  • Reconcile all medications, including refills, to ensure your patients are taking them as prescribed. Identify medication duplication, inaccurate pill counts and medications not being refilled on time. 
  • Look for underlying conditions: for example, patients who are depressed rarely take their medications, so consider treating the depression first.

Identify why the patient is not taking their medicine.

You can do this by developing a process for routinely asking questions such as:  

  • “Do you have all of the medications you were prescribed with you?” (If not, probe for barriers such as cost or confusion.)
  • “If you have asthma, do you have a spacer? Do you carry a rescue inhaler wherever you go?” 
  • “Do you understand why you are taking them?”
  • “Many people have trouble taking their medications on a regular basis. Do you find that this is the case for any of your medications? For example:
    • Do you ever forget to take your medications?
    • Do any of your medications make you feel sick? If so, do you stop taking them?
    • If you feel better, do you stop taking your medications?”

Respond in a positive tone of voice and thank the patient for sharing their behavior.

Tips for improving medication adherence

Make it as easy as possible for the patient to take their medication at the right frequency and time.

For example:

  • Minimize polypharmacy by deprescribing medications that are no longer indicated and not benefiting the patient.
  • Give the patient a pill box that organizes medications by day of the week (and even time of day).
  • Help the patient set recurring alerts on their phone or online calendar reminding them when to take medication.

Simplify the patient’s prescription regimen.

For example, when clinically appropriate: 

  • Prescribe combination medications or extended-release formulations.
  • Consider letting the patient take all their medications at the same time of day.

For patients with chronic conditions:

Synchronize all prescriptions to be renewed during one yearly visit, such as the annual checkup or wellness visit.  

Write for a 90-day supply with four refills (“90x4”) for prescriptions to decrease prescription renewals and the number of trips to the pharmacy.

Set the patient up for success:

  • Partner with them on a treatment plan with solutions tailored to their individual needs. 
  • Use the “teach-back” method to confirm that the patient understands their medications and their treatment plan. If the patient may need to take the medicine for the rest of their life, explain the reasons for this in a way that they understand.
  • Give them an updated medication list at the end of each visit that highlights any changes to their treatment plan. If the patient agrees, also give a copy of the treatment plan to a family member or caregiver.

Use the SIMPLE medication adherence method:

  • Simplify the regimen
  • Impart knowledge
  • Modify patient beliefs and behavior
  • Provide communication and trust
  • Leave the bias
  • Evaluate adherence

Learn more about SIMPLE

Resources

American Academy of Family Physicians

American Medical Association 

Centers for Disease Control and Prevention

Empire Blue Cross Blue Shield

Health Plan of San Mateo

Society of General Internal Medicine