Medication Adherence Is So Easy...Right?

Just take the medication(s)!

Medication adherence is so simple to solve. You just give them some education and the patient will take the medication. If they don’t take their medication they are non-adherent and there is no hope for them.

This is the view of many people and even me at the beginning of my career. This all changed one day when I met a patient during my rotations. We will call her Olivia.

Olivia was a very “difficult” patient with very uncontrolled hypertension and diabetes. Her doctor referred her to us and our preceptor would see her every couple of weeks.

During this rotation, I would review the patient’s chart before the appointments and discuss my recommendations with my preceptor. Then we would go in and talk to the patients and if appropriate make our recommendations to them and answer any questions they had. It was an amazing rotation.

But there was this one patient, Olivia, that was extremely non-adherent and refused to take her medication. The first time I met her was with my preceptor. We went through the standard questions. How are your blood pressures and blood sugars? Are you taking your medications? Why not? Then told her that she needs to take her medications. Then she would say yes she will do better. This song and dance went on at every appointment.

After the first week, I started seeing some patients on my own. I would still discuss my recommendations with my preceptor and then met with the patients. Then one day I saw Olivia’s name on our schedule and my preceptor looked and me and asked if I was comfortable seeing her on my own. In my mind, I was scared as hell, but I said Yes!

I walked into the room and went through our standard questions. I then went a little rogue. I knew there was something more to this. She kept talking about how proud she was to get her numbers down, but they weren’t coming down. They were all over the place. Sometimes they were normal but most of the time they were elevated. She was talking about all the healthy foods she has been eating and how she was exercising.

I asked her why she is not taking her medications. She was trying to get better but something wasn’t adding up. I kept pressing her. And then she told me that she was proud of being able to do it without any medications. So it was not of a lack of trying. She just wanted to do it without the help of medications. I told her I empathized with what she was trying to do but, her disease was not controlled and if she didn't get this under control it could lead to further complications. We didn’t talk about anything medical after that. I just sat and listened to her. At the end of the appointment, I told her that I was proud of how far she had come and if she could try taking her medications and just see what happens. She begrudgingly said yes.

Fast forward a couple of weeks and she was back. I went in to see her and to my surprise, she told me that she is getting better at taking her medications but had missed a couple of days. I can’t tell you how happy I was. I told her that it was ok and I was glad she was making an effort. My preceptor was also excited. Let’s just say I did alright in that rotation!

The reason why I am telling this story is that medication adherence is more complicated than a patient just not taking their medications.

I love technology, but it is hard for technology to empathize. It is hard for technology to get to the root cause of the problem sometimes. What technology can do is supplement these interactions!

Here are some ways to tackle medication adherence with digital solutions.

Chatbots

Send a message to your patients asking if they are taking their medications with a yes/no selection. Then if they say no, ask them why they have not. The main reasons we see for non-adherence are they just simply did not pick up the medication, forgot to take it, were too expensive, had adverse reactions, or just didn’t want to. All of these issues can be resolved once we know about them.

The problem with the way we practice medicine right now is there is poor follow-up when the patients leave. This is not because we don’t care. It is just we don’t have the time to do it properly. This is why chatbots are great. They can work at any time and gather all the necessary information needed to properly triage. And that is what they should be used for. It will allow you to optimize your time on patients that need more attention before an ER visit

Telehealth

Services like medication therapy management (MTM) were created for this exact purpose. They are usually run by pharmacists.

This is when a pharmacist talks to the patients and evaluates the medications they are on. The great thing about this solution is you can not only evaluate medication adherence but also see if the patient’s therapy can be optimized. The pharmacist can also look into adverse reactions, polypharmacy, and if the patient is even taking their medications properly. Also, you could let the pharmacists manage the patient’s disease state and adjust their medications within set parameters agreed upon with their physician.

Can you tell that I am a pharmacist?

Hardware

Some interesting solutions exist in this space. To me, these will only work if there is nothing extra that the patient has to do. If the patient is having a hard time taking their medication for whatever reason then adding another step to the process is not going to help at all!

Remote Patient Monitoring (RPM)

Thinking a little bit outside of the box here. You are monitoring for adherence by looking at the effectiveness of the therapy. For example, If you see that their blood pressure is not getting any better with the new medications you can be prompted to reach out to the patient.

Let’s go, Voltron Force!

Why not use all the systems together and form the ultimate defender of the universe?

Form feet and legs!

This would be your chatbot system reaching out to the patients and gathering the necessary information to help you triage your workload.

Form arms and body!

RPM and MTM would be actively monitoring and working with your patients to take care of any issues before they become major issues.

And I form the head!

You will always need in-person visits. Some things can only be done in person, and also, some people still prefer the personal touch. As much as we try to make algorithms to replace clinicians I don’t think we will get to that point anytime soon. Anyone who has ever worked in medicine knows the majority of it is not black and white. It is gray.

As you can see tackling medication adherence is more than just blaming patients for not taking their medications. There is a multitude of reasons why someone does not take their medications, but with a comprehensive hybrid model, I think we can tackle it!

Thank you so much for your support! Please do not hesitate to reach out if you have any questions or leave a comment.

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I hope you have a great day!

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