Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Medication Non-Adherence by Rheumatology Patients & What Rheumatologists Can Do

Jennifer Stichman, MD, and Dennis J. Boyle, MD  |  Issue: April 2015  |  

The most important thing we can do as practitioners is to remember that non-adherence is a prevalent problem and to ask our patients if and how they are taking their medications. If answers are discordant from available pharmacy data, one needs to address the discrepancy.

It’s easy in clinic visits to focus on side effects and disease control, but asking more open-ended questions, such as, “Do you have any concerns about your medications?” or “What might get in the way of you taking this medication?” might give a patient space to share whatever problem they are having.

ADVERTISEMENT
SCROLL TO CONTINUE

A shift in physician mentality from non-adherence to shared decision making can be helpful in improving adherence to medication and improving disease control.

Jennifer Stichman, MD, is an assistant professor of general internal medicine at Denver Health and the University of Colorado.
Dennis J. Boyle, MD, is an associate professor of medicine and rheumatology at Denver Health and the University of Colorado.

ADVERTISEMENT
SCROLL TO CONTINUE

Highlights & Tips

  • Medications only work when taken.
  • Rates of non-adherence are much higher than we think.
  • Non-adherence is associated with poor outcomes.
  • Non-adherence is an issue for patients from any socioeconomic background.
  • Ask patients in an open fashion how they take their medicines.
  • Do anticipatory problem solving around medications.
  • Explore patient worries and concerns about medications.
  • Use the teach-back method.
  • Write or print a med list at the end of every visit.
  • Enlisting the patient in their care is as important as making the correct diagnosis.

References

  1. DiMatteo MR. Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Med Care. 2004 Mar;42(3):200–209.
  2. Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010 Apr;25(4):284–290.
  3. Foster SA, Foley KA, Meadows ES, et al. Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance. Osteoporos Int. 2011 Feb;22(2):551–557.
  4. Reach G. Treatment adherence in patients with gout. Joint Bone Spine. 2011 Oct;78(5):456–459.
  5. Grijalva CG, Chung CP, Arbogast PG, et al. Assessment of adherence to and persistence on disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis. Med Care. 2007;45(10 Suppl 2):S66–S76.
  6. Blum MA, Koo D, Doshi JA. Measurement and rates of persistence with and adherence to biologics for rheumatoid arthritis: A systematic review. Clin Ther. 2011 Jul;33(7):901–913.
  7. Kleinman NL, Brook RA, Patel PA, et al. The impact of gout on work absence and productivity. Value Health. 2007 Jul–Aug;10(4):231–237.
  8. van Hulst LT, Kievit W, van Bommel R, et al. Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: Results of a maximum difference scaling experiment. Arthritis Care Res (Hoboken). 2011 Oct;63(10):1407–1414.
  9. Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011.

Related Articles