II. Epidemiology
- Chronic medications are not taken as prescribed in up to 50% of cases
- New medication prescriptions are not filled in up to a third of cases
III. Approach
- Assess Medication Compliance at every visit (analogous to checking Vital Signs at each visit)
- Ask about problems taking medications and missed doses
- Review medication refill patterns with pharmacy if non-compliance is suspected
- New medications should receive focus
- Explain why the medication is indicated and for how long
- Anticipatory guidance on adverse effects
- Select Generic Medications or employ cost cutting methods (e.g. cut larger dose tablet in half)
- Encourage Medication Compliance through education
- Explain benefits of medication
- Review correct schedule of medication
- Discuss ways to reduce adverse effects
- Patient should be able to paraphrase the key education points in their own words
- Give an active, updated medication list at each visit (part of after visit summary)
- Employ reminder systems to take medications
- Use pill boxes
- Time medication delivery with daily activities
- Consider alarms or phone applications to issue reminders
- Consider mobile applications (e.g. Medisafe, Dosecast)
- Bad-Tasting Medications
- Some medications may be mixed with sweet thick liquids (e.g. coffee creamer, chocolate syrup, apple sauce)
- Examples inclde Dexamethasone, Tamiflu
- Medications typically taste better when chilled (or consider sucking a popsicle before dose)
- Consider following medication with a sweet beverage
- (2020) presc lett 27(2): 11
- Some medications may be mixed with sweet thick liquids (e.g. coffee creamer, chocolate syrup, apple sauce)
- Involve pharmacists
- Consider pharmacy consultants to review medications with patients
- May help to eliminate compliance barriers (e.g. cost, adverse effects)
- Patients should share their medication lists with their pharmacists
- Allows for screening for Drug Interactions and duplicate Medication Classes
- Perform Medication Synchronization
- Work with the pharmacist to synchronize refill dates
- Coordinate all medications to be filled on the same date (with 90 day supply)
- Will require some medications with a smaller number of pills dispensed
- Patient may need to pay extra to resynchronize refills
- Work with the pharmacist to synchronize refill dates
- Consider pharmacy consultants to review medications with patients
- Involve others
- Involve family members to assist with Medication Compliance
- Combination Medications
- Combination agents may simplify medication regimens and in the case of Generic Drugs, further drop cost
- Reasonable strategy when medication doses are stable and Generic Medication use
- Many of the HIV Treatment regimens combine multiple agents
- Combination Medication disadvantages
- Unable to modify the combination drug components in different ratios
- Cause of adverse effects less clear when a combination agent was recently started
- Cost may be considerably higher than taking individual pills (combinations may extend a patent)
- References
- (2020) Presc Lett 27(7):40
- Combination agents may simplify medication regimens and in the case of Generic Drugs, further drop cost
IV. Associated Conditions: Disorders commonly complicated by Medication Nonadherence
- Cardiovascular conditions
- Endocrine conditions
- Gynecology
- Infectious Disease
- Antibiotic noncompliance overall is common (missed doses, stopping course early)
- HIV Infection (Antiretroviral therapy)
- Lung conditions
- Neurologic conditions
- Psychiatric conditions
V. References
- (2014) Presc Lett 21(10): 59
- (2013) Presc Lett 20(12): 68-9