Medication Adherence in Mental Health: Working Together to Help Patients Take their Medication as Prescribed
Julie M. Palmer DNP Student
Dr. Janene Luther Szpak, DNP, PMHNP-BC
Robert Morris University
The United States Surgeon General reports that seventy-five percent of Americans have trouble taking their medications as prescribed. Taking medications as prescribed by your healthcare provider is often called medication adherence. Medication nonadherence means not taking your medications as prescribed by your healthcare provider and this can have serious implications on your health and well-being. Medications work only if they are taken as prescribed by your healthcare professional. Not taking your medications as prescribed or stopping your medications on your own can cause your symptoms to worsen, medical problems such as seizures, suicidal thoughts, or in some cases the need for hospitalization. It is necessary for patients and their healthcare providers to work together as a team so that the best medication regimen for the each individual patient is chosen and individualized strategies are used to help patients take their medications as prescribed.
Barriers to Taking Medication as Prescribed
There are many reasons why patients may not take medications as prescribed, this is why it is important for healthcare professionals and patients to work together to discover what barriers exist for the patient and to work on solutions to promote medication adherence. Some of the barriers to medication adherence include the following: characteristics of the illness being treated, cost (including high copays), confusion about medication regimen, frequency of expected intake, managing multiple medications, denial of need, inability to remember to take medications, taking more medication than prescribed, cultural beliefs, and stigma associated with psychiatric medication. Nonadherence to medications is the highest when patients are symptom free, patients begin to feel better and may decide that they no longer need their medications and stop taking them altogether. Strategies to Promote Medication Adherence
Perhaps the most important strategy to promote medication adherence is a conversation between the healthcare provider and patient. The responsibility of educating the patient about the prescribed medication, the symptoms of illness it is targeting, the possible side effects, and how the medication is taken lies with the healthcare professional. Open communication between the healthcare provider and patient about any barriers the patient recognizes to medication adherence is of utmost importance. Addressing these barriers prior to the start of the medication regimen can assist with promoting adherence. Barriers will be individualized to each patient and prevention strategies must also be individualized. Script Your Future, a program dedicated to promoting medication adherence encourages patients to “Ask Me 3”; this is a simplified approach to become more involved in your own healthcare experience. “Ask Me 3” consists of three questions that patients can ask their healthcare provider: 1-What is my main problem?, 2-What do I need to do? and 3-Why is it important for me to do this? “Ask Me 3” can simplify what may seem like a complex conversation when discussing psychiatric illness and medications as part of the treatment. Asking these three questions can help patients to better understand their illness, what treatment is involved, what symptoms their medications are targeting, and the importance of taking medications as prescribed. Any issues or side effects that occur after a medication is started should be communicated with the healthcare provider. Never stop a medication on your own as serious health risks may occur, always talk to your provider before stopping a medication.
Patients who have difficulty remembering to take their medications may benefit from the use of a pill box, using an app that reminds the patient when medications are due, linking medications with something else that you do at the same time everyday, or by having a friend/family member help. Using a pill box can be helpful for patients to keep track of their medication by the days of the week and can help to simplify managing multiple medications. Smart phones have various apps that are available for free or at low cost that help patients to manage their medications by alerting when medications are due and also offer valuable health information. By taking medications when doing routine tasks you will be more likely to remember them. For example, a medication that is to be taken 3 times per day could be taken with breakfast, lunch, and dinner and this medication could be kept in the kitchen to assist with remembering to take it. Another example would be to take bedtime doses of medications when brushing your teeth. A supportive friend or family member can be a helpful resource for you to remember to take your medication also.
Script Your Future’s website, scriptyourfuture.org has resources to assist patients with management of their medications and promotes medication adherence. The website offers free printable resources such a wallet cards, medication lists, a question generator for visits with providers, personalized pledges to commit to medication adherence, and more.
If cost of medications is a barrier to taking medications as prescribed your healthcare provider can be a good resource to troubleshoot ways for you to afford your medication. Coupons may available for certain medications from your healthcare provider which offer free medication trials or can help to reduce high copays. There are also programs that are income based that assist patients with paying for their medications. Simply changing the pharmacy where you fill your medication can also help to lower the cost. Your healthcare provider is a good resource on which pharmacies will price match medications and/or offer medications at low cost. If you are unable to afford your medication or find that your copay is more than you can afford, discuss your options with your healthcare provider so that it doesn’t keep you from taking medications that you need to treat your symptoms.
Medication nonadherence is a major problem in our country. Nonadherence to psychiatric medications can cause symptoms to worsen and/or return, medical problems, suicidal ideations, and the need for hospitalization. It is important for patients and healthcare providers to communicate with each other to determine what possible barriers the patient may have to taking medications as prescribed so that these barriers can be avoided for the greater good of the patient.
Benjamin, R.M. (2012). Medication Adherence: Helping Patients Take Their Medicines As Directed. Public Health Reports, 127, 2-3.
Burley, P. (2007). 10 Barriers to compliance-and how to overcome them. Modern Medicine Network. Retrieved from http://www.modernmedicine.com/modern-medicine/content/10-barriers-compliance-and-how-overcome-them?page=full
Cowan, M. (2010). Adherence to Medication. Nursing Standard, 25(2), 59.
Dayer, L., Heldenbrand, S., Anderson, P., Gubbins, P.O., & Martin, B.C. (2013). Smartphone Medication Adherence Apps Potential Benefits to Patients and Providers. Journal of American Pharmalogical Association, 53(2), 172-181.
Gottlieb, H. (n.d.). Medication Nonadherence: Finding Solutions to a Costly Medical Problem. Retreived from http://www.medscape.com/viewarticle/409940_print
Lamb, E. (n.d.). Strategies and Tools for Promoting Medication Adherence. Pharmacy Times. Retrieved from http://www.pharmacytimes.com/print.php
Script Your Future. (2014). Retrieved from http://www.scriptyourfuture.org
Worley, J. & McGuinness, T.M. (2010). Promoting Adherence to Psychotropic Medication for Youth-Part 1. Journal of Psychosocial Nursing, 48(10), 19-22.
Worley, J. & McGuinness, T.M. (2010). Promoting Adherence to Psychotropic Medication for Youth-Part 2. Journal of Psychosocial Nursing, 48(12), 22-26.