The more patients know and understand the more likely they are to make better, fact-based decisions about their health. This is especially true in medication adherence. A poor understanding of why a medication is prescribed, how it works, and its possible side effects can make it impossible for the patient to distinguish between side effects and unrelated conditions. In effect, it reduces the patient’s engagement in their care and increases the probability that the patient may not continue taking their medications as directed.
Along with reviewing directions for taking the medication and any possible side effects, it is important to review with patients how their medications work. The discussion does not have to be a complicated journey into the biochemistry of pharmaceuticals, but a simple statement about what the drug does to the body and, if known, how it does it. Take for example the class of drug known as SGLT2 inhibitors, drugs used for the treatment of high blood glucose. Explaining to a patient that this type of drug helps lower blood glucose by preventing the kidneys from storing excess glucose and eliminating the excess in urine may help them more easily recognize the connection between a urinary tract infection and the drug.
It is also important that patients understand the rationale behind dosing. For many patients, the cost of prescriptions can be a concern. They may cut pills in half to make them last longer. Other patients may assume that taking less of a prescribed medicine will help alleviate some side effects they are experiencing. Unfortunately, neither of these are effective solutions, and depending on the medication, altering the prescribed dose can negate the efficacy of the drug or even cause harm. For example, patients with diabetes who have a blood glucose reading in range or even slightly below range before bedtime may think it is wise to skip taking their basal insulin not understanding that the purpose of basal insulin is to maintain glucose levels overnight not to lower them.
Many medications must reach a threshold level in the body before they are efficacious. For some drugs, this build-up is quick while others may require several weeks or even months before a therapeutic level is reached. In diabetes treatment, the drug class thiazolidinediones, which work by making the body’s cells more sensitive to insulin’s action, can take two to three months to achieve the full effect.
Although knowledge about medications alone is not sufficient to assure medication adherence, it is one of the major building blocks for patients to achieve the skills and behaviors they need to be true partners in their care and make sound decisions about the medications they are prescribed.
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.