A better way to assess patient medication compliance
By Stormy Fanning, RN, MSN
Patient noncompliance with taking their medication as prescribed is a significant health problem. Approximately 40% of patients do not take their medication correctly. 1 Healthcare professionals can contribute to this problem by giving incomplete or confusing instructions to the patient. The first step in addressing this problem is to identify the noncompliance in the patient.
There are many reasons patients do not take their medications as prescribed. Some common reasons a patient would not take their medication are:
- Unpleasant side effects
- The patient forgets to take their medication, or only remembers some of the time
- They cannot afford the medication
- The medication interacts with lifestyle (for instance, an athlete would not want to take an anticoagulant because then they could not play sports)
- The patient is unable to obtain it from the pharmacy (possibly due to lack of transportation)
In healthcare, we need to ask ‘why’ questions, but in our culture, asking a person ‘Why did you do that?’ comes across as accusatory or criticizing. But there are instances when we need to know the ‘why’ so we can identify the best way to help the patient. An alternative wording is to ask the patient ‘What was the reason you weren’t able to take your medication?’ This removes blame and judgment and communicates that we understand there may be a valid reason for not taking the medication.
That reason may not seem valid to the healthcare professional, but it is valid to the patient. This is not the time for a lecture. Pointing out that their current health problem is a result of not taking their medication will just prompt them to be less honest with health professionals in the future to avoid another lecture.
A patient may be taking their medication but not as prescribed. For instance, a medication is supposed to be taken twice a day, and the patient remembers the morning dose but forgets to take the evening dose. When asked if they are taking their medication, they will answer ‘Yes’. It is important to follow up with ‘When was your last dose?’ or ‘Have you missed any doses?’ This provides an opportunity for them to be honest about their doses without fear of confrontation.
The reason for the noncompliance may be easily identified and addressed with just a few more questions. A person may not want to take their diuretic at breakfast because they have an hour-long drive to work, and it is inconvenient to make a bathroom stop halfway there. In this instance, the person could take the dose once they arrive at work and they have easy access to a bathroom.
Another example is timing for a patient with an abnormal schedule. Patients are typically told to take thyroid medication first thing in the morning. The reason for this is that it needs to be taken on an empty stomach because food affects the absorption of the drug. If the patient is a night shift worker, and no one explained the reason for the timing of the morning dose, they may be taking the medication first thing in the morning, which is actually their bedtime, and their stomach is not empty. That patient could change their dose to afternoon when they first wake up and their stomach is empty.
Building trust with the patient is vital so they will be honest with you. Body language, facial expressions, and tone of voice are just as important as the actual words we use. Once our patients feel comfortable knowing that they will not get a harsh reply, scowl, or rolled eyes from the provider, they are more relaxed and willing to be open about their compliance.
Returning patients who have their medication list already in an electronic system are especially tricky. It is easy and convenient to just ask, ‘Any changes to your medications?’ to which the patient will likely reply, ‘No.’ Staff need to go through each medication specifically to determine if it is still being taken and if it is being taken correctly. It is also important to remember that patients frequently know their medications only by what they are for, not their actual names. They know they take ‘a water pill and something for my blood pressure’ and sometimes when they are prompted with the word ‘furosemide’ or ‘lisinopril’, then they remember the actual name.
Medication noncompliance accounts for roughly $100 billion in preventable healthcare costs each year. 1 Healthcare professionals can reduce that cost and detriment to the patient by taking a little extra time and patience. It is part of our pledge to ‘do good’ to our patients.
1The Unmet Challenge of Medication Nonadherence by Fred Kleisinger, MD. Published online 2018 Jul 5. doi: 10.7812/TPP/18-033 PubMed Central.
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