Physicians frequently encounter patients who report adherence to a medication regimen despite evidence or clinical knowledge showing the opposite. Medication adherence is a very important aspect. Once a patient is diagnosed and prescribed medicines, then comes the major part of medication adherence. This is where the patient has to play his part to resolve his condition. Medication non-adherence can lead to disease progression, disease-related complications, higher mortality rates, increased hospitalizations, and reduced quality of life.
What are a few simple ways to check if a patient has taken/consumed the medicine?
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Asking the patient – this is the simplest method to know whether or not a patient has taken the medicine. But sometimes, just to avoid more medications or to prevent any additional cost, the patient would claim to have taken the medicine. This is not a reliable method of checking medication adherence.
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Pill Counts – counting the number of pills left, with the days and frequency administered is a good way to check the medication adherence.
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Pharmacy Prescriptions – Pharmacists can check the last time a patient came to refill his/her medications and check whether it was refilled on time or not. Additionally, asking the patient about it and counselling him/her can help in medication adherence.
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Smart Pill Box – smart pill boxes are provided to the patient, which tracks their pill time and date. These are a part of a Medication Event Monitoring System (MEMS). From this, we can know the exact time and day the patient takes medication and misses the dose. However, this is still a new concept and many patients do not rely on it.
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Weight Checking – checking the weight of the cream/ointment before and after its use and comparing the difference obtained with the daily defined dose will help to understand if the patient is applying the cream/ointment properly. However, this is a very vague method as the exact amount of the drug may not be applied.
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Questionnaires – several questionnaires such as the Morisky Medication Adherence Scale (MMAS-4) can help to find out medication non-adherence.
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Physiological Parameters – parameters such as blood pressure, RBS, etc. can be used to check adherence as well as drug efficacy, but it doesn’t always indicate non-adherence.
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Therapeutic Drug Monitoring – this is a method by which we can measure the concentration of drug in the body. However, it is costly and performed only for a few drugs.
Patients are to be counselled and explained clearly about medication adherence. Regular follow-ups and transparency will help in medication adherence.
What can be the reasons for medication non-adherence and how can we, as healthcare professionals, help in solving those issues?
MBH/AS