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by Neoteryx Microsampling on Jan 17, 2018 5:03:00 AM
Medication adherence, defined as the extent to which a patient complies with prescribed medication regimens, is a critical component of effective treatment and recovery.
However, clinical professionals frequently encounter uncertainty regarding patient adherence to medication protocols. Contributing factors include patients' lack of involvement in decision-making and confusion about prescriptions and procedures.
Studies indicate that up to 50% of individuals do not take their medication as prescribed.
Medication adherence is often the determining factor between patient recovery and deterioration of health.
Non-adherence has been associated with drug resistance, accelerated disease progression, irreversible health complications, and increased mortality.
To achieve improved clinical outcomes, it is essential to implement patient-centered solutions that address the underlying causes of non-adherence.
Benefits of medication adherence extend beyond avoiding the risks above. When a patient follows their prescription to the letter, adherence can help:
- Minimize drug wastage by reducing interruptions in treatment and the subsequent need for additional medication when symptoms recur.
- Reduce overall healthcare costs, as consistent medication use supports recovery and decreases the likelihood of avoidable return visits and complications.
To improve medication adherence, consider implementing the following strategies in combination.
1) Patient Education
Patients are primarily responsible for medication adherence; thus, patient education is a fundamental strategy for improvement.
Research demonstrates that, on average, patients retain only half of the information discussed during consultations with medical professionals.
Patient education encompasses more than disease-specific programs. It also involves directing patients to additional professionals who can provide advice and support, such as:
- Community health teams
- Local pharmacists
- Access to high-quality online resources
Practical strategies to enhance patient education
- Utilize clear language and consistently reinforce the rationale for the prescribed medication.
- Verify patient understanding, for example, by requesting that the patient articulate the medication plan in their own words.
- Develop a straightforward, step-by-step medication plan that aligns with the patient's daily routine.
Medication Adherence: WHO Cares? (Mayo Clin Proc. 2011 Apr;86(4):304–314. doi: 10.4065/mcp.2010.0575 ) https://pmc.ncbi.nlm.nih.gov/articles/PMC3068890/
2) Patient Empowerment
Educating and informing patients plays a crucial role in empowering them and giving them a sense of control over their treatment. Something as simple as asking the patient what time of day is best for them to take their medication can have a huge impact.
One way to strengthen empowerment is self-monitoring (also known as self-tracking, biomonitoring, or health and wellness monitoring). Self-monitoring is among the many patient monitoring techniques that not only track a patient’s progress, but can also support awareness of medication intake and effectiveness.
A common example is self-monitoring blood pressure at home, which has been used to help people with hypertension track progress without needing to visit the clinic as often.
Remote devices and patient-friendly monitoring routines can help patients work more closely with their care team and have more agency in managing their health to get things back on track.
Applying this approach to additional aspects of diagnosis and treatment, such as remote blood collection, further enhances patient autonomy and increases the likelihood of adherence to medication regimens, thereby supporting ongoing well-being.
Evidence also indicates that volumetric absorptive microsampling (VAMS) can be utilized for adherence monitoring in therapeutic drug monitoring contexts. (link.springer.com)
Practical strategies to enhance patient empowerment
- Provide reasonable choices whenever feasible, such as options for medication timing, reminder methods, and follow-up formats.
- Ask about barriers early (“What might get in the way of taking this consistently?”).
- When clinically appropriate, implement patient-centric sampling options to minimize obstacles and enhance engagement. (link.springer.com)
- Consider integrating digital technologies, wearable devices, and remote specimen collection to support self-monitoring and decrease dependence on frequent in-clinic visits.
3) Economic Constraint Reduction
Although many patients intend to adhere to prescribed medication regimens, financial constraints can significantly impede their ability to do so. Common challenges include:
- Cost of medicine
- Arranging work around potential side effects
- Missing work to attend medication reviews
Facilitating access to financial assistance, offering appointments at convenient times, and enabling at-home monitoring through technological advancements, such as remote blood collection, can substantially improve medication adherence.
Additionally, self-monitoring and remote monitoring approaches reduce the frequency of clinic visits, allowing patients to maintain employment while remaining engaged in their care. Practical strategies to address economic constraints
- Proactively discuss affordability and work constraints (patients may not raise this on their own).
- Streamline follow-up procedures and minimize unnecessary in-person visits when clinically appropriate.
- Adopt monitoring approaches that decrease the time, travel, and appointment burden for patients. (link.analytica-chimica-acta)
4) Patient–Physician Relationship Building
Trust, respect, and understanding, established by considering patients’ religious and cultural beliefs and attitudes, are essential for promoting medication adherence.
Physicians should explain the composition of medications and, when necessary, offer alternative therapies that align with the patient's beliefs.
Patients who trust their physicians are more likely to adhere to prescribed medication regimens. Practical strategies to enhance patient–physician relationships
- Normalize adherence challenges to encourage honesty (patients may fear judgment).
- Encourage early discussions regarding patients' beliefs, concerns, and preferences.
- Ensure that follow-up interactions are supportive and non-punitive.
5) Adverse-Effects Mitigation
Adverse effects of medication are a significant concern for many patients. Encountering information about potential side effects solely through medication package inserts can be overwhelming and distressing.
Physicians can significantly improve medication adherence by explaining potential adverse effects, their likelihood, and appropriate actions to take if they occur. Practical strategies to mitigate adverse effects
- Explain what is common vs. rare, and what to do if symptoms occur.
- Establish clear criteria for when patients should contact the clinic or seek urgent care.
- Emphasize that managing side effects is an integral component of the treatment plan, rather than an indication of failure.
Closing the gap — development of an analytical methodology using volumetric absorptive microsampling of finger prick blood followed by LC-HRMS/MS for adherence monitoring of antihypertensive drugs ( Research Paper. Published: Volume 415, pages 167–177, (2023) https://link.springer.com/article/10.1007/s00216-022-04394-9
A Comprehensive, Patient-Centered Approach
No single approach is sufficient in isolation. To substantially improve medication adherence across patient populations, these strategies should be integrated into a comprehensive, patient-centered framework that combines clear education, shared decision-making, relationship-centered care, side-effect management, and, when appropriate, self-monitoring options such as digital tools, wearable devices, and remote specimen collection.
Further supporting publications (patient-centric microsampling for adherence monitoring)
- VAMS method in finger-prick blood applicable for adherence monitoring of antipsychotics (published Jan 30, 2021). (link.springer.com)
- VAMS finger-prick blood methodology for adherence monitoring of antihypertensive drugs; the article notes VAMS suitability and comparable adherence classification to plasma in their proof-of-concept. (link.springer.com)
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