Improving Adherence
A Practical Single Question Shown to Identify Low Adherence:
“Have you missed any pills in the past week?”
Other Ways to Assess Non-Adherence (previously validated in research settings)
- Did you ever take less medicine because you felt you needed less?
- Sometimes if you feel worse when you take the medicine, do you stop taking it?
- How many days in the past week did you forget to take your BP medication?
- How many days in the past week did you not take your medication on purpose?
- How many days in the past week did you add an extra pill?
- Some people have difficulty taking BP medication as prescribed. Do you have difficulty with this?
Adherence Conversations with Your Patients
BACKGROUND: Common reasons for non-adherence include:
- Lack of knowledge about importance of control
- Skepticism about importance of control
- Side effects
- Complex regimens
- Cost
- Substituting folk remedies or Complementary/Alternative meds and fearing side effects if conventional meds are taken too.
Guiding principles: Some patients need “permission” to tell you they are not following the plan; once the patient knows you understand the challenges and that you want to work with them just like any other problem, collaboration is more likely.
ASK: It’s hard to take medicine every day, day after day, without missing. How is it for you?
TELL:
- Now we know how important it is to control your (blood pressure, cholesterol, diabetes) so you’ll be less likely to have strokes or heart attacks or kidney failure.
- We can work around problems like side effects and dose schedules and cost. We can change what you’re taking or the way you’re taking it.
- Let’s look at what would help you the most.
ASK:
- What would help you the most?
- What could you do differently? How does that sound?
- I want you to stay protected, so will you promise to give me a phone call before you stop taking a medicine because of a side effect?
At the next visit: How did it go with taking your medicines? What do you think of these pills?
Some tips for remembering your medicines:
- Make it a routine, like brushing your teeth. Take your medicines at the same time each day.
- Use a weekly pillbox.
- If you can’t afford all your medicines, talk about that with your doctor. There might be cheaper options available.
- If you think you may be having side effects, tell the doctor. There may be other options.
Free Medication and other Benefits Available to Your Patients
Access to drugs for patients may have a significant impact on patient care outcomes.
For those who cannot afford their drugs, a central website, the Partnership for Prescription Assistance (PPA), has been established to assist:
- Physicians and other healthcare professionals
- Patients, family members, and care givers
Go to the Partnership for Prescription Assistance (PPA) website https://www.pparx.org
Low Cost Hypertension Medications
Patients’ participation in certain prescription drug coverage plans may entitle them to pay even less than $4 for certain generic drugs. If eligible, patients will be charged the lowest applicable amount.
See information about the Prescription Program at Walmart (PDF - 5 pages) and the Target Pharmacy Program (PDF - 3 pages)
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