Turning the tide on medication adherence

Medication nonadherence is a significant problem in our healthcare system with far-reaching consequences, resulting in more than 10% of hospitalizations, between $100 billion and $289 billion in healthcare costs, and nearly 125,000 deaths each year. By not taking prescribed medication, patients not only fail to effectively manage the condition they were trying to take, but may also experience additional adverse effects due to incorrect or inconsistent dosing. In some cases, this can lead to absences from work or social activities, mental health problems in addition to physical problems, increased health insurance costs, etc. What’s most frustrating is that the problem is largely preventable.

While some factors, including cost and accessibility, pose greater, longer-term challenges to good medication management, there are several ways physicians themselves can better engage patients to improve patient outcomes. compliance and results.

Make medicine collaborative

The first challenge to making medication management a more engaging and collaborative process for patients is the very language we use to discuss it. The terms “compliance” or “adherence” can understandably have negative connotations for many patients, implying a one-sided relationship in which patients feel like they are being punished or told what to do. This lack of commitment to the process, not to mention the very human nature of resisting being told what to do, creates a perfect storm for medication mismanagement.

Another challenge is that we as doctors often fail to really explain to patients Why they should take medicine. For example, a patient with high blood pressure may not really understand why it is a problem beyond the fact that they are not hitting target numbers. It’s our job to connect the dots for patients, explaining in this case how high blood pressure can put a strain on their heart, which can lead to various other problems, and how it affects their day-to-day health.

There also needs to be a more collaborative discussion with patients about the medications they are taking. This is certainly not always the case, but more often than not there are several potential medications or other treatment options to manage a condition. When this is the case, we as physicians should talk to patients about the different drugs available, the pros and cons of each, and what we recommend professionally. Ultimately, however, it is up to the patient to decide which medications they are actually taking. Patients have their preferences and we must respect them.

Additionally, physicians should consider medication regimens when promoting better patient management. Research shows that medications taken more than once a day are less likely to be adhered to. It is important to stay abreast of the latest treatments and consider whether the marginal benefit of double dose treatment over a single dose may be worth the potential (in some cases probable) mismanagement.

Finally, the conversation about medication shouldn’t end when the prescription is written. Physicians need to be accessible to patients to talk to them about how the drug works for them, how often they use it as prescribed, and what barriers they face in using it. It’s best to take the time and have another conversation with a patient about other alternatives, then make them feel like they can’t come back to you to ask questions or express dissatisfaction, and finally quit altogether. to take his medication.

Conclusion

While many of these changes in practice may take more time to implement – ​​something physicians certainly don’t always have plenty of – a growing number of digital health tools can help patients simply engage in a few clicks on their smartphone. Unfortunately, many doctors are still not trained and educated on the importance of a patient-centered approach, and it is up to all of us in practice and in academia to change the script on how we approach Medicine.

Photo: Sarinyapinngam, Getty Images

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