Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Abstract

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decisionmaking for clinicians interested in providing patientcentered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of nonadherence to medications for chronic conditions. A dherence to medications is often suboptimal-up to 50 % of patients do not take their prescribed medication as recommended. 1-4 Medication non-adherence is associated with adverse health outcomes as well as negative social and economic consequences. [5][6][7] The problem of medication nonadherence is often multifaceted and multifactorial; in general, most conceptual models of medication non-adherence take an ecological perspective, and include patient factors (e.g., literacy, cognitive function), provider factors (e.g., complex regimens), social/community factors (e.g., access to providers and pharmacy), health care factors (e.g., interaction with healthcare system, trust, prior authorization, fragmentation), and policy implications (e.g., coverage of medication). 8-10 Thus, to be effective, interventions designed to improve appropriate medication use must adopt a comprehensive approach, often combining numerous proven strategies. Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.Evidence increasingly demonstrates that adopting a personcentered approach for medication use that incorporates patient beliefs, preferences, goals, and barriers to medication-taking (e.g., cost, technological ability, concerns about medication prescribing and use) leads to better clinical outcomes. 17,18 Clinicians are in a key position to elicit this information from patients and to incorporate it into medication-related decisions, thereby improving medication adherence rates. Person-centered care focuses on providing patients with greater choice, recognizing their roles as consumers of health care who know best their own beliefs and preferences. This care is meant to encourage value concordance-in this case, the match between the treatment that is selected and the treatment that i...

Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials

“…Furthermore, a paper by Bosworth et al [35] highlights the promise of using patient-centered care approaches, such as motivational interviewing, counseling, and shared decision-making, to improve medication adherence for those with chronic conditions. The authors recommend the following strategies to improve medication adherence: (1) generate options to give the patient an opportunity to be involved in his or her care; (2) decide on a mutually agreeable and measureable regimen; (3) understand a patient’s knowledge on their chronic condition; and (4) screen for readiness to change (i.e., improve adherence) [35].…”

“…The authors recommend the following strategies to improve medication adherence: (1) generate options to give the patient an opportunity to be involved in his or her care; (2) decide on a mutually agreeable and measureable regimen; (3) understand a patient’s knowledge on their chronic condition; and (4) screen for readiness to change (i.e., improve adherence) [35]. Future studies are needed to examine the impact of these strategies on medication adherence and related health outcomes in older adults.…”

Cultural Issues in Medication Adherence: Disparities and Directions

“…One study at urban HIV clinics asked healthcare providers to self-rate their cultural competency. 67 66,67 Perceived discrimination may be reduced Medication beliefs may be addressed/understood Complementary and alternative medication use more likely to be discussed Patient-centered communication training for providers 68,69 Perceived discrimination may be reduced Patients' concerns (medication beliefs, CAM use, depressive symptoms) more likely to be addressed Implicit bias training for providers (AAMC)…”

Non-Adherence to Prescribed Therapies: Pharmacare’s Existential Challenge

“…This is one example of the important role the pharmacist can have in supporting patient adherence. However, a multidisciplinary approach is needed, with patient-tailored interventions designed to address those factors that influence non-adherence, monitored over time, with partnerships among trained health professionals, patients, families and patient organizations (Bosworth et al 2017;McGinnis et al 2014;Steiner 2012;WHO 2003). Such collaboration could lead to improved adherence rates, which in turn could positively impact patient health outcomes and health system effectiveness.…”