A frequent and challenging issue affecting the management of a patient’s chronic health conditions is the owner’s non-adherence to prescribed therapy. In human medicine, adhering to prescribed therapy has been proven to reduce hospitalizations, improve health outcomes by controlling disease states, decrease healthcare costs, and prevent progression of disease. Below I outline ways to address potential causes of non-adherence.
- Forgetting to give the medication. Solutions include setting alarms using smart devices, using pill organizers, and/ or simplifying the regimen. The first two options are fairly straightforward. Simplifying the regimen, however, may take more thought. One option would be to change from a short-acting formulation to a once-daily long-acting formulation, if available. Alternatively, you could substitute medication in the same class or similar action that offers longer duration of action. An additional idea would be to consider alternative routes of administration (i.e., injection vs. oral).
- Complexity of the medication regimen. This obstacle may arise when a patient is on several medications with differing timing or when the owner has to manipulate the medication to be given. It can be streamlined by using long-acting medications over short-acting ones or, if available, by prescribing tablet sizes that do not have to be split in half or quarters.
- Adverse effects. If a patient is experiencing severe or bothersome side effects, the client may be less willing to continue the treatment. Before clients leave the clinic, they should be counseled on how to give the medication and to anticipate adverse effects. This discussion should include ways to prevent or mitigate any adverse effects.
- Cost. This may be the most common cause of non-adherence. Be mindful of the total cost of all prescribed medications to make sure the therapy remains affordable. When available, lower-cost generic options can be prescribed. Combination products (i.e., two drugs in one capsule/tablet) can reduce the number of medications being given and potentially the total cost.
Clear, honest communication between prescribers and clients ensures the client’s buy-in and leads to adherence. Focus on the long-term goals of the prescribed therapy and provide positive reinforcement, when possible, to build the client’s confidence in caring for the patient. Watch for nonverbal cues to ensure understanding and agreement.
By Erin White, PharmD
