Prescribed medications are at the forefront of treating many chronic health conditions, and managing existing conditions is essential to overall health. Medication nonadherence results in greater health care spending and poorer patient health outcomes. 

One study in the Annals of Long-Term Care reported nonadherent diabetes patients were twice as likely to be hospitalized.1 Plus, medication adherence challenges are likely to worsen as patients continue to postpone routine health care visits.

The CDC reports that certain chronic conditions, including diabetes, kidney disease, chronic obstructive pulmonary disease, and sickle cell disease, can place patients at high risk of serious illness from coronavirus disease 2019, making medication adherence even more critical.2
 
Increased medication nonadherence could have lasting consequences for population health. This article will discuss challenges in medication adherence and strategies pharmacists can use to help patients overcome them and improve their health.

1. Patients may not feel empowered to control their own health
One effective intervention for improving medication adherence is having focused, one-on-one conversations with patients using motivational interviewing. Instead of telling patients why they need to take their medication and hoping they do so, motivational interviewing puts the patient in charge.

Pharmacists engage patients with open-ended questions, allowing them to describe their experiences in their own words. Pharmacists use reflective listening to demonstrate empathy while providing subtle direction to the conversation. 

The technique honors patients’ autonomy and ultimately engenders behavior change with plans they’ll commit to because they were part of the creation. Pharmacists can then follow up with additional calls to check on patients. This process greatly improves medication adherence because the impetus for change comes directly from patients’ own plans. 

2. Patients may be unable to access medications and unaware of helpful options
Many patients experience barriers to getting their prescriptions when they need them. Myriad obstacles exist, including cost, lack of transportation, or limited mobility.
 
Pharmacists can address these challenges in medication adherence by educating patients about their prescription options. If patients are unable to afford a prescription, pharmacists could recommend generic or otherwise more affordable options.

If patients are physically unable to obtain their medications, pharmacists could inform them about any available options such as mail-order prescriptions and 90-day supplies. A study in the Journal of the American College of Cardiology suggests that longer-day supplies can improve patients’ adherence to medication.3 

3. Health literacy limitations could prevent patients from understanding and following treatment plans
Many patients experience limitations in understanding and communicating about health information and services that could help them make better health decisions. If patients have trouble reading and understanding the information provided to them around their medication plans, they’re unlikely to adhere to the treatment correctly. What’s more, patients may not fully grasp the benefit or importance of adhering to their treatment plans if they have low health literacy. 
 
Pharmacists can help by clearly explaining medication instructions to patients in terms that are easy to digest and follow. Accompanying verbal instruction with clearly written details or graphics and charts to illustrate the steps and benefits of adhering to medication plans can also help. By translating complex or confusing prescription information into simple, clear instructions and education, pharmacists can encourage greater medication adherence among populations.
 
Medication nonadherence takes a significant toll on population health, but much of the problem lies in patients’ limitations to access and understand the right treatment and medication information. Pharmacists can help improve medication adherence by communicating with patients to fully understand their needs and empower them to take control, sharing available options that could make adherence easier, and educating around the instructions and importance of following their treatment plans.

References
1. Nonadherence to Oral Diabetes Medications Linked With Increased Hospitalizations, Costs [Article] September 17, 2020. https://www.managedhealthcareconnect.com/content/nonadherence-oral-diabetes-medications-linked-increased-hospitalizations-costs. Accessed November 9, 2020.

2. People with Certain Medical Conditions [Webpage] November 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed November 9, 2020. 

3. Difference in Medication Adherence Between Patients Filling 30- Versus 90-Day Prescription Supply After Acute Myocardial Infarction [Article] March 10, 2018. https://www.onlinejacc.org/content/71/11_Supplement/A69. Accessed November 9, 2020.

About the Author
Dr. Misquitta is Vice President of Clinical Pharmacy at Envolve. She obtained her Doctor of Pharmacy degree from the University of the Pacific. She completed a pharmacy practice residency at the University of California Davis Medical Center and is board certified in both Pharmacotherapy and Geriatrics. She earned her Master of Business Administration from the UC Davis Graduate School of Management and has been recognized by the California Society of Health-System Pharmacists as a fellow. She has been working in managed care for 20 years, overseeing clinical programs, drug information, innovation, and strategy.