Medication adherence is a well-known problem across the board, but the stakes are even higher with the treatment of certain diseases, such as HIV, hepatitis C, and cancer. How a health professional responds to a patient who has compliance gaps can make a big difference, contends M. Barton Laws, Ph.D. from Brown University. He set up a “fly on the wall” study by recording and analyzing all of the doctor-patient conversations at routine outpatient visits of 415 HIV patients at a specialty clinic.
Dr. Laws and his fellow researchers, publishing their results of this study in the journal AIDS and Behavior, found that doctors and nurse practitioners were most likely to lecture, issue orders, or asked closed or leading questions when discussing adherence. Providers asked very few open-ended questions and almost never checked-in with patients to see if they understood the discussion content.
Here at BioPlus, we teach our staff to ask patients open-ended questions about medication adherence. Positive encouragement is the order of the day, with lots of praise included in these discussions.
If one of our patients is missing doses, our responses likely include:
• “Is there anything I can help you do to get back on track?”
• “Do you understand why you can’t miss these doses and clear your virus?”
• “Is there a particular time of day you are missing them?”
Based on the patient’s answers, we’ll give some hints on how to overcome medication adherence challenges. For example, if a patient tends to forget an evening dose of a medication, I might ask “is there a TV show that you watch every night?” If the answer is yes, that show can serve as the reminder to take the medication. I remember one woman I worked with who never missed an episode of “Wheel of Fortune.” When Vanna started turning the letters, that served as her reminder to take her evening meds. In fact, I use Lipitor commercials to remind me that it’s time to take my pill and keep my cholesterol levels in check.
The personal relationship our staff at BioPlus forms with our patients steers the direction of our individualized medication adherence plans. It’s slightly different for every patient, although a common approach is the suggestion to set a phone alarm or perhaps a particular ringtone on a smartphone to serve as a medication reminder.
Sometimes we can simply change the patient’s dosage design as a simple fix for increased medication adherence. For example, with the hepatitis C medication ribavirin, I might use a 600 mg. pill size instead of three 200 mg. Or perhaps I switch the patient to Ribapak, a package that provides the morning and evening dose labeled so there is no guess work if someone is fatigued and forgetful.
Our TAP App allows us to portal to the physician’s office the results of a patient’s adherence so they can join us in celebrating the patient’s success on the next office visit and help with providing ongoing education and encouragement to adhere to the prescribed regimen.
No matter which methods we develop with a patient, we know that it takes time, encouragement, and a trusting relationship – never preaching or lecturing. We have been more successful than most with this approach, as seen in our compliance statistics which show a 91 percent compliance rate at discharge. And, just for the record, we haven’t given up on that other 9 percent – we’re still talking and working with them.
Stephen C Vogt, PharmD
President and CEO
Barton Laws M, Beach MC, Lee Y, et al. Provider-patient adherence dialogue in HIV care: Results of a multisite study. AIDS and Behavior January 2012, 1-12, doi:10.1007/s10461-012-0143-z.