Medication nonadherence is a significant problem in our healthcare system with wide-reaching consequences, leading to over 10% of hospitalizations, between $100–$289 billion in healthcare costs, and nearly 125,000 deaths each year. By not taking medications as prescribed, patients not only fail to effectively manage the condition they were trying to, but may also experience additional adverse reactions from incorrect or inconsistent dosing. In some cases, this can lead to missed work or social activities, mental health challenges in addition to physical, rising health insurance costs, and more. What’s most frustrating is that the problem is largely preventable.
While some factors, including cost and accessibility, represent larger and more long-term challenges to proper medication management, there are several ways in which physicians themselves can better engage patients to improve adherence and outcomes.
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Making medicine collaborative
The first challenge to making medication management a more engaging and collaborative process for patients lies in the very language we use to discuss it. The terms“compliance” or “adherence” can understandably carry negative connotations for many patients, implying a one-way relationship in which patients feel like they are being punished or told what to do. That lack of engagement in the process, not to mention the very human nature to resist being told what to do, creates a perfect storm for medication mismanagement.
Another challenge is that we, as physicians, often fail to really explain to patients why they should be taking medication. For example, a patient dealing with high blood pressure may not truly understand why it is a problem beyond that they are not hitting target numbers. It is our job to connect the dots for patients, in this case explaining that high blood pressure may put a strain on their heart which can lead to various other problems, and how that impacts their day-to-day health.
There also needs to be more of a collaborative discussion with patients about what medication they are taking. It is certainly not always the case, but more often than not, there are several potential medication or other treatment options for managing a condition. When that is the case, we as physicians should be talking patients through the different medications available, the pros and cons of each, and what we professionally recommend. At the end of the day, however, it should ultimately be the patient’s decision about what medication they actually take. Patients have their preferences and we should respect them.
A Personalized Approach to Medication Nonadherence
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Furthermore, physicians should consider medication dosing schedules when it comes to supporting better patient management. Research shows that medications that are taken more than once per day are less likely to be adhered to. It is important to stay on top of the latest treatments, and consider if the marginal benefit of a double-dose treatment over a single-dose may be worth the potential (in some cases likely) mismanagement.
Finally, the conversation about medication shouldn’t end when the prescription is written. Physicians need to be accessible to patients to talk about how the medication is working for them, how often they are using it as prescribed, and what barriers they have to using it. It is better to take the time and have another conversation with a patient about other alternatives, then to have them feel like they can’t come back to you to ask questions or express dissatisfaction, and ultimately stop taking their medication altogether.
Conclusion
Although executing many of these changes in practice may require more time — something physicians certainly don’t always have much of — a growing number of digital health tools can help patients engage simply through a few clicks on their smartphone. Unfortunately, many physicians are still not being trained and educated on the importance of a patient-centered approach, and it is on all of us in practice and in academia to change the script about how we approach medicine.
Photo: Sarinyapinngam, Getty Images
For over twenty years Danny Sands, MD has worked at the intersection of health care, technology, and business. His career began at Beth Israel Deaconess Medical Center, where he trained in clinical informatics and went on to develop and implement numerous systems to improve clinical care delivery and patient engagement. He has served as chief medical officer for Zix Corporation and chief medical informatics officer at Cisco providing both internal and external health IT leadership and helping key customers with business and clinical transformation. He currently serves double duty as Chief Medical Officer for Medisafe and continues to see patients as a primary care physician at Beth Israel Deaconess Medical Center.
Dr. Sands has earned degrees from Brown University, Ohio State University, Harvard School of Public Health, and trained at Boston City Hospital and Boston’s Beth Israel Hospital. Sands is the recipient of numerous health IT awards, has been elected to fellowship in both the American College of Physicians and the American College of Medical Informatics, and is a founder and co-chair of the board of the Society for Participatory Medicine. He is the co-author, with e-Patient Dave deBronkart, of Let Patients Help.
