This is the fifth installment of our “Top Six Barriers to Medication Adherence” blog series. Read our introductory blog post, the article on cost and financial concerns, the post on side effects and the article on motivational gaps.
Patients who report having a good relationship with their healthcare provider have higher medication adherence rates than those who do not. A lack of trust in your healthcare provider, limited communication with your doctor, seeing multiple healthcare providers and the overall complexity of navigating the healthcare system can all be barriers to medication adherence.
A lack of trust can occur if a provider changes a prescription, neglects to renew a prescription, doesn’t explain side effects and expectations clearly, is unavailable or difficult to reach, or provides unclear messaging that confuses the patient. Compounding this issue, the healthcare system can make medication adherence challenging with restricted access to care, lack of care coordination among physicians or limiting the time providers have to spend with patients. A third party, like Health Dialog, can coach patients through these barriers to adherence.
Provider Issues Impacting Medication Adherence
According to an analysis conducted by Health Dialog regarding diabetes medications, provider-related medication adherence barriers are most often related to the member reporting at least one of the following:
- Have not spoken to provider recently
- Next appointment is in a few months
- Provider is trying different medications to see what works
- Provider is taking the member off medications because he/she is doing well
- Provider told the member to stop taking the medication while sick
- Member is unsure if the provider has stopped prescribing the medication
- Missed doses due to problems switching pharmacies
- Multiple providers telling the member different things
- Member is looking for a new provider
Disjointed healthcare systems create major barriers to medication adherence. In order to address these provider-patient concerns, a team-based or coordinated care approach has shown to increase medication adherence. In a recent study, patients assigned to team-based care were more adherent to their medication plan 12 months after hospital discharge (89%) compared with patients not receiving team-based care (74%).
Communication between physicians and health systems is often lacking and contributes directly to medication nonadherence. Demonstrating this issue, one study found, “Direct communication between hospitalists and primary care physicians occurs in less than 20% of hospitalizations, and discharge summaries are available at less than 34% of first post-discharge visits.”
Preparing Patients for Provider Visits Can Improve Medication Adherence
Many patients feel shame in not taking medications as prescribed and don’t want their provider to know what has really been happening or preventing them from taking their medications. Cost issues, forgetfulness, fear, ambivalence, miscommunication, lack of understanding and lack of importance should all be communicated with providers and helping patients frame these conversations is key to opening the lines of communication.
Assisting patients in preparing for their provider visits is an important part of Health Dialog’s medication adherence strategy. Helping patients formulate pointed questions for their providers and uncovering areas where further knowledge and clarification is needed is critical to strengthen the patient-provider relationship.
Examples of the types of questions we encourage patients to ask their providers are:
- Do I need to keep taking a statin even though my cholesterol is not high anymore?
- What should I expect when taking Lisinopril?
- How long will I have to take metformin?
At Health Dialog, our medication adherence team acts as part of the coordinated care approach to healthcare and can build patients’ confidence to adhere to their medication regimen.
In the next installment in our blog series “Top Six Barriers to Medication Adherence,” we will discuss patient knowledge gaps as a barrier to medication adherence.
 Brown, M.T., Bussell, J.K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings.
 Neiman, A.B., et al (2017). CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management—Innovations and Opportunities. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. November 17, 2017.