If we think about the patient at the heart of care we cannot be blind to patient adherence. The topic is already many times debated in particular because it is complex. Is the person taking the right medicine, at the right dosage, at the right time, taking into account other medicines and thus be aware of possible drug-drug interactions, with a necessary amount of fluid or food, will the person return to pick up prescriptions at regular intervals,…?
Once a patient told me that the only way she could swallow her pills was by putting them in the middle of the table, walking – almost dancing- around the table twice while concentrating her mind on taking the pills and then quickly throw them in her mouth and swallow. No other “trick” made her motivated enough to swallow her medicines every day.
So indeed adherence isn’t that easy but oh so important as bad adherence may lead to poor clinical outcomes, increasing healthcare costs, lost productivity or a patient may even die. With good adherence, you may get an increased quality of healthcare, increased care management, better patient outcomes.
A pill-box with a lipstick and a mirror
Physicians have a not easy task as besides making the diagnosis and determining the right treatment they have to check if the patient will adhere to the treatment. In fact, it is better to find out the patient’s willingness to adherence before he/she leaves the consultation with the prescription in the pocket. Physicians, helped by nurses and sometimes even social assistants (one strong patient-provider relationship is wished for) need to find out what the behavioral pattern, demographic and lifestyle choice is of the patient and check if this can fit with one’s treatment. What drives the patient to adhere and what will it be for the individual as it may be different for everyone. I remember we proposed a very small pill-box to an African lady as her family would be very suspicious on why she takes medicines and thus the original pillbox could not be taken home and it had to fit in her purse. However, this was not the final solution as she still feared somebody finding the little box and then there was still the step of getting the pills out of the box and taking them. To make a long story short (because adherence counseling may indeed take a long time and it may take months to get somebody ready to be adherent) we found that one act she would never be asked about is why she puts on lipstick. So another small box was developed that contained a mirror, a lipstick holder, and space for the pills. As she puts on lipstick daily, she combines this act with swallowing her pills.
It may be difficult to get everybody adherent as it is time-consuming. When a choice needs to be made it is best to choose first those patients who need the most support and offer them a personalized intervention. Many organizations, companies keep on developing tools and devices to support adherence. Watches with timers, text messages, app’s, small robots who even watch the person swallowing the pill, can be useful although sometimes it can be just the money for a bus ticket to come to the doctor and get a prescription.
Last modified: June 6, 2018