Patient adherence to medications is one of the greatest challenges that any healthcare professional can face.  Whether it comes to identifying benefit, potential side effects, or drug interactions, patient adherence should be the first question you think about.  In the end, if the patient isn’t taking the medication that we think they are, nothing about that medication really matters.  Here’s a list of 5 ways I try to assess patient adherence.

1. Ask them.  It’s simple and easy, but not always effective.  Using opened ended questions here can be helpful versus simply asking “if they are taking their medications as they are supposed to”.
2. Refill records.  Whether you work at the pharmacy the medications are dispensed at or are working in another setting, refill records can really tell you a lot.
3. Caregivers, family or friends.  Now, we certainly have to mindful of HIPAA, but I’ve done numerous MTM visits where the spouse is there with the patient.  Spouses/family members tend to be more honest about how their loved one is taking their medications.
4. Asking about cost.  Cost is often a hidden factor if we don’t ask about it.  I’ve seen a handful of patients that will ration their maintenance therapy (something like LABA/ICS therapy for asthma) because it is too expensive for them.
5. Lack of improvement/adverse effects.  If an antihypertensive medication is started and/or increased and the patient’s blood pressure does not respond, I’m will have a strong suspicion that they patient may not be taking that medication as directed.  If a patient is reporting adverse effects, many patients will stop or reduce the dose on their own if they think it is due to a new medication.  Erectile dysfunction as well as frequent urination are two adverse effects that come to mind, that may be embarrassing for some patients to report.

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