Convincing patients with chronic diseases to take their medication correctly and consistently can be difficult. Medication non-adherence creates a variety of maladaptations ranging from treatment failure to dangerous pharmacological interactions, all negatively impacting the patient’s health. The financial costs are also staggering. Hospitalizations caused by non-adherence costs upwards of $100 billion (about $310 per person in the US) annually. Since non-adherence can have many triggers, it is necessary to tackle the problem from both the individual and the institutional level. Silver Fern offers tools that can help providers identify, understand, and respond to a patient’s individual reasons for diverging from expected behavior.
Barriers to Adherence
Medications, along with diet and exercise, provide the foundation of therapeutic interventions for many chronic diseases. Medication adherence improves outcomes and reduces symptomology, and mortality. At present, one in five prescriptions are never filled, and of those filled, only half are taken correctly. Barriers to medication adherence can be broadly classified into two groups: those that are practical and those that are perceptual, as defined by the National Institutes of Clinical Excellence Adherence guidelines.
Practical barriers are those external or internal environmental factors that affect a patient’s medication-taking behavior. Practical barriers include issues such as the medication side effects, the complexity of the medication regimen, ease of obtaining and paying for the medication, as well as the patient’s cognitive function and literacy. When the right questions are asked to properly identify the problem, practical barriers tend to be concrete and easier to solve. Most practical barriers impede the patient’s desire to comply with doctors’ recommendations and properly take their medications.
Conversely, perceptual barriers can be much harder to identify. In general, patients’ non-adherence beliefs are related to fears of dependence on medication, long-term side effects, and the perception that medications are overprescribed by treating providers. Each person’s beliefs are specific to them and should be addressed as such.
Uncovering patients’ beliefs and preferences is crucial to engaging the patient in their treatment plan. It is the first step to discussing why taking the medication consistently or, in some situations, why stopping the medication, would be beneficial.
Addressing the Barriers: Solving the Problem
Non-adherence is often a hidden problem that does not become known until a negative medical event occurs. The first step to understanding and reversing medication non-adherence is establishing a trust-based, blame-free relationship in an atmosphere where patients feel comfortable discussing their views.
In their paper, “Understanding Patients’ Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework,” Home et al. discuss a phased approach to improving medication adherence:
- Communicating a common-sense rationale for the personal need for medication adherence that takes account of the patient’s perceptions of the illness and symptoms, expectations, and experiences;
- Eliciting and addressing the patient’s specific concerns; and
- Making the treatment as convenient and as easy to use as possible.
Practitioners who want to employ this approach need tools that help them systematically and consistently assess patients’ experiences, perceptions, and barriers. Silver Fern’s Medication Taking Module specifically addresses patients’ current medication-taking behaviors and whether the behaviors diverge from best practice. For those patients who indicate a lack of medication adherence, a series of questions are introduced to determine the rationale behind their reluctance. Patients’ responses to these questions supply the clinician with the background to start a conversation that can uniquely address individual concerns and define the clinician’s treatment goal. It should be noted that the results of such conversations may not conclude with the patient taking the initial medication prescribed. Following such a discussion, the patient and their health care provider may choose a different medication or another therapy to advance the treatment plan.
Digging Deeper
The scope of the problem establishes that it is woefully inadequate to assume that patients will always fill their prescriptions, begin taking their medication, and continue taking their medication as prescribed. Understanding how practical and perceptual factors influence patient decisions is important in helping patients reach treatment goals.
In addition to Silver Fern’s Medication Taking module, which unlocks information about patients’ current behaviors, goals for medication taking, and barriers to adherence, Silver Fern offers supplementary modules on topics such as social determinants of health, cognitive functioning, health literacy, and behavioral health that explore ancillary issues that can have an enormous impact on medication taking behaviors. Once the patient’s barrier(s) are discovered, Silver Fern provides actionable suggestions to assist the provider in resolving the patient’s concerns and determining an appropriate care path.
We know that helping patients achieve their individual medication objectives can lead to a reduction in disease burden and improved quality of life. Use of the Silver Fern tools can help organizations meet health care outcome metrics assigned by third-party payors which can improve ratings and have a positive monetary impact for the provider organization.
Nora Saul is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Nora has more than 25 years of experience in the field of diabetes education, consulting for the Joslin Diabetes Center and other industry partners. Nora leads content development for Silver Fern’s diabetes products and training.
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