This is the fourth installation of our “Overcoming Barriers to Medication Adherence” blog series. Read our introductory blog post to learn the common characteristics of medication non-adherence and how to identify the patient-level barriers to adherence.
Simply put, a lack of provider trust, limited communication with a provider, delivery of care by multiple providers, and the overall complexity of navigating through the healthcare system can all be barriers to medication adherence.
In fact, Health Dialog found that patients identify provider issues 8% of the time. A provider may change a prescription, communicate ineffectively about expectations and side effects related to medications, forget to refill a prescription, be unavailable or difficult to reach, or provide unclear messaging causing confusion for the patient. The health system may further exacerbate these medication adherence barriers by restricting access to care, not enabling coordination of care amongst physicians and, therefore, limiting the time physicians have to spend with patients during each visit. Patients who report having a good relationship with their healthcare provider have higher medication adherence rates than those who do not.
What Provider Issues Impact Medication Adherence?
According to an analysis conducted by Health Dialog regarding diabetes medications, provider-related medication adherence barriers are most often related to the patient reporting at least one of the following:
- Not spoken to provider recently
- Next appointment in a few months
- Provider is trying different medications to see what works
- Provider is taking the patient off medications because he/she is doing well
- Provider told the patient to stop taking the medication while sick
- Patient is unsure if the provider has stopped prescribing
- Missed doses due to problems switching pharmacies
- Multiple providers telling the patient different things
- Patient is looking for a new provider
Disjointed health care systems create major barriers to medication adherence. In order to address these provider-patient concerns, a team-based or coordinated care approach has shown to increase medication adherence. In a recent study, patients assigned to team-based care were more adherent to their medication plan 12 months after hospital discharge (89%) compared with patients not receiving team-based care (74%). Communication between physicians and health systems is often lacking and contributes directly to medication nonadherence. “Direct communication between hospitalists and primary care physicians occurs in less than 20% of hospitalizations, and discharge summaries are available at less than 34% of first post discharge visits”
A Coordinated, Team-Based Approach is Key to Improving Medication Adherence
Team-based / coordinated care may include the following:
- patient education
- pharmacist-led medication reconciliation and tailoring
- collaborative care between pharmacist and primary care provider
- educational and medication refill reminder calls
- improved health information technology
Patients in this study reported that team-based care improved their comfort in asking clarifying questions, raising concerns about their medication regimen, and collaborating in developing their treatment plan.
Assisting patients in preparing for their provider visits is an important part of Health Dialog’s medication adherence strategy. Helping patients formulate pointed questions for their providers and uncovering areas where further knowledge and clarification is needed is critical to strengthen the patient-provider relationship. Many patients feel shame in not taking medications as prescribed and don’t want their provider to know what has really been happening or preventing them from taking their medications. Cost issues, forgetfulness, fear, ambivalence, miscommunication, lack of understanding, and lack of importance should all be communicated with providers and helping patients frame these conversations is key to opening the lines of communication.
Examples of the types of questions we encourage patients to ask their providers are:
“Do I need to keep taking a statin even though my cholesterol is not high anymore?”
“What should I expect when taking Lisinopril?”
“How long will I have to take Metformin for?”
At Health Dialog, our medication management services staff acts as part of the team-based approach and can build patients’ confidence to adhere to their medication regimen. Learn more about how our health coaches can improve medication adherence for your population.