Are Your Patients Listening To You?

At the TEDMED conference in October, 2010, Thomas Goetz, an editor at Wired Magazine, observed that patients are not following through with the health information that is given to them:  they don't take their medications and they don't follow their doctor's advice.  A recent study published by the New England Healthcare Institute (NEHI) supports this observation.  Only one half of people surveyed by NEHI said they take their medications as prescribed.  NEHI estimates that poor medication compliance can add as much as $290 billion each year to total medical spending.  High tech solutions like cell phone reminders and chirping pill bottles are being considered as solutions; however, we shouldn't overlook more important and potentially more effective low tech solutions such as improved communication between clinicians and patients.

Research conducted by pharmaceutical companies about medication non-adherence has revealed the following:

• Patients are primarily concerned about side effects, the need for the medication and the cost
• Compliance is hardest for patients who are being treated for diseases whose symptoms are not obvious, such as cardiovascular disease
• When asked directly about medication adherence, patients overestimated their level of compliance

These findings suggest that clinicians can encourage adherence by focusing their conversations on specific patient concerns and explaining the positive impact of compliant behavior on a patient's disease.  Eric MacLaughlin and his colleagues at Texas Tech University also found that more reliable information about medication adherence was gained by using open-ended, indirect questions such as, "Can you tell me how you take your medications?"  In fact, the Texas Tech researchers determined that this may be the best way to gain information from elderly patients, a group particularly vulnerable to poor medication adherence.

I agree with the conclusions reached by MacLaughlin and his colleagues that, "medication adherence demands a relationship between a patient or caregiver and prescriber that values open honest discussion about medications."

What strategies are you using to discuss medication adherence with your patients?