Improving medication adherence

When I'm trying to get patients to understand their medications and to take their medications, I ask the question, “How do you take your medication?” I frame it so that it doesn't prompt a yes or no answer. The response usually tells you a whole lot about the patient's ideas, philosophy, and understanding and allows you in turn to offer suggestions such as, “Could you try it this way? Or how about this way?”

For example, I say, “How are your medications working? Do they bother you? What happens if you forget to take your medication?” These are all open-ended questions, and they're helpful. I learned one of my patients was getting her insulin shots through her pants, and I was able to say, “We know it works better if you just do it right on the skin.” Explain to the patient what you know.

If you prescribe a patient a daily medication, you only get about 70% compliance. We're trying to get people to understand and take the right medications, and there's no point in adjusting medication the patient hasn't taken in the first place. A lot of patients don't like pills; they think it's a negative. So when they seek treatment and I prescribe them a pill, once they leave my office, they don't have to think about me or the pill. That's normal human behavior.

In geriatrics, it's also important to be a little more careful about the choice of the medicine and the dose of the medicine, the timing, and how each interacts with other medications. The average geriatric patient is on 12 drugs. Patients often ask, “Do I need these?,” and I use that opportunity to explain and reinforce what each medicine is for.

I also help patients prioritize medications. I say, “So your medication priority is this one, right? Your hypertension, you've got to have that; your heart is a priority. So if you're going to skip taking some, skip these, don't skip these,” and I explain why.

Since I do continuity of care, I'll see my heart patients, hypertension patients, and pulmonary comorbidity patients every four months. I pick a drug and focus on that, because I can't do everything in one visit. This gives me more time to review the medications, talk about patients' concerns, and connect their prescription regimen with all the other specialists they are seeing.

I also watch carefully for how patients connect things that are not really connected and try to educate them about that. They'll say, “Well, you know, my right hand is burning every time I take this pill,” and you're thinking, “OK, well, probably not related,” but to them, it's important. I might say, “Not everything is connected to everything in our body; if your hand feels different it may be positional meaning due to how you move your neck or shoulder. So a pill you take would not have any effect on one arm, but remember that you can always check with me if you have a concern.”