Encouraging patient compliance with medication regimens is an ongoing challenge with serious consequences. Some surveys show that as many as half of patients do not comply with their doctors’ directions for taking medications. The blame shifts between busy physicians and patients who claim that they are given inadequate information and instructions, if any at all.
“Doctors always seem to recall spending a great deal of time on instructions, and the patient says they were never told anything by the doctor,” said James L. Griffith, JD, an attorney with Fox Rothschild in Philadelphia, Pennsylvania. Griffith has represented patients and physicians in malpractice lawsuits which involve doctors’ directions to patients.
A recent article in Medscape Business of Medicine lists five simple tips for proactively improving medication compliance among patients.
Query Patients About Noncompliance
The reasons why patients do not comply with physician orders are not always related to a stubborn unwillingness to take their medications as prescribed. Some patients have cognitive problems, others may be depressed or lack a support system to reinforce their regimens. Zeroing in on the real reasons gives physicians a chance to intervene in a constructive way, rather than simply criticising patients for their noncompliance.
A technique called “motivational interviewing” is used by physicians to quickly reveal obstacles and address them directly with patients. A simple five-minute chat in which physicians ask questions, and then ask permission before offering advice to the patients, results in improved reception to physician instructions. Thousands have doctors have been trained in the technique, developed by Montreal-based behavioural psychologist Kim Lavoie, PhD.
Hold Regular Reviews For Patients On Multiple Medications
Patients who are prescribed several medications, some of which must be taken according to strict schedules, benefit from periodic “interviews” with their physicians to generate accurate medication lists. Physicians can invite patients to bring their medications with them to office visits, but it is important to limit discrepancies with the drugs brought in by patients and others they report taking. Such regular reconciliation is also important for older patients who could benefit from reminders of when, why and how to take their medications.
Simplify Medication Regimens
Reducing the number of pills, or the number of times per day a patient must take his or her medications, can significantly improve compliance. Studies have shown that compliance is higher when patients are able to take a fixed dose of combined drugs, rather than separate medications. This is not always possible, of course, but it is worth considering in order to relieve a patient’s pill burden.
The timing of when patients take their medications is another variable that can be altered to improve compliance. If patients are advised to take medications before bed, but fall asleep before they can do so, physicians might suggest taking the pills in the morning instead. It may go against the advice of their pharmacists, but educating patients about valid options can increase the likelihood that they will actually take the prescribed medications.
Cut Costs Whenever Possible
The inability to afford medications is a major reason for patients not complying with physician instructions. In a 2014 Medscape report, less than one third (32 percent) of physicians said they regularly discuss the cost of treatment with patients. Avoiding this conversation means it is impossible to know for certain whether patients can afford the drugs being prescribed to them.
Physicians can stay informed about the costs of medications by accessing websites that compare costs across several pharmacies. Generic drugs are be available for many prescriptions, and pharmacies can usually quickly determine drug costs based on a customer’s insurance provider. In the US, financial assistance may be available to help Medicare recipients to pay for the costs of some medications.
Educate Patients and Confirm Their Understanding of Instructions
Time is typically limited in the patient-physician encounter, and many physicians sacrifice patient education in order to stay on schedule. After all, they might think, medications come with product information which patients can read at home. However, many patients are not aware that simplified patient instructions can be found at the end of the dense scientific jargon.
Health literacy represents a real problem which can be overcome when physicians take a few extra minutes to discuss how to take the medications, the potential side effects and adverse events. The American Medical Association recommends the “teach-back technique”, in which patients are asked to repeat the instructions given by their doctor in order to confirm comprehension.
Source: Medscape Business of Medicine
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