CHAPTER 8: ADDRESSING PATIENT NONADHERENCE
Prior to the patient’s visit, you are reviewing his chart to evaluate potential reasons for nonadherence. Which one of the below is the most likely treatment-related barrier to medication adherence for AN?
B. Complexity of treatment
Rationale: Potential barriers to medication adherence can be categorized as patient related or treatment related. Patient-related barriers include lack of motivation, depression, denial, cognitive impairment, substance or alcohol abuse, cultural or alternate beliefs, and low healthcare literacy. Treatment-related barriers may include complex treatment regimens, actual or the concern for potential side effects, inconvenience, cost of medications, and time management.2,3 The patient is on greater than five medications that are taken multiple times a day, thus answer B is most likely the barrier. Lack of motivation and low education level are patient-related and not treatment-related barriers (rules out answers C and D). Cost is less likely to be the treatment-related barrier as most of the medications in his list are generic and the patient has a prescription plan (rules out A).
Which of the following is an optimal way to measure adherence in this patient?
A. Having the patient fill out a simple questionnaire about adherence
B. Conducting a “brown bag” medication review and pill count
C. Contacting the pharmacy to get his prescription fill record
Rationale: There is no one optimal way to measure a patient’s adherence. It is important to use multiple methods to clarify the medications, as each method has its advantages and disadvantages. For example, it is important to call the pharmacy get a prescription record to assess if he has picked up his new medications and refilled his old medications. However, this can be inaccurate since the patient has been in and out of the hospital multiple times. Pill count is an objective and easily measurable but can be susceptible to error, especially if patients mix up their pills, throw them out, or are hospitalized. In addition, pill counting does not give you information about the timing of the pills consumed by the patient. A patient questionnaire is very simple and useful but is dependent on patient’s recollection.
Which of the following questions is appropriate to ask when assessing the patient for adherence?