By: Dr. Carolyn Rodríguez, PharmD MCS Executive Vice President of Pharmacy

Lack of therapeutic adherence is a major public health problem. According to research, more than 50% of people with a chronic disease do not comply with their treatment. Although patients are the ones who ultimately decide upon this behavior, healthcare professionals have an important role in the person’s decision. Below are several practical tips and resources to help improve your patients’ drug adherence.

Identify and evaluate non-compliance

Consider adherence to a drug as a vital sign that must be verified during every interaction with the patient.

Ask patients open-ended guilt-free questions. For example: “Tell me how you take each of your drugs. Are you taking your drugs as prescribed?”

Use interactive modules to help patients and staff identify adherence issues and strategies to improve adherence.

Optimize therapy

Evaluate the drugs when consulting with patients, either during the drug use review (DUR), or after hospitalization.

Synchronize medical follow-up appointments with the number and duration of drug refills. Article 5.02 of the Puerto Rico Pharmacy Act (247-2004) allows the dispensing of a noncontrolled drug prescription, including refills up to twelve (12) months after the date the prescription was issued.

Familiarize yourself with the health plan’s prescription drug formularies, so you can choose therapies that are accessible to your patients.

Help patients remember

Minimize the number of drugs a patient takes. You can use combination products when appropriate, and skip duplicate drugs or those with a low risk/ benefit ratio.

Simplify the dosage regimen. Adherence may improve with once-daily dosing. You can also choose a once-a-day drug with a prolonged duration of action or half-life to minimize the possibility of a patient missing doses.

Communicate effectively with the patient

Ask the patient about his or her beliefs regarding drugs. For example, whether the person believes the drug works, is harmful, etc.
Avoid medical jargon and use simple everyday words that are based on the patient’s level of health literacy.

Resource	Access Link
Interactive Module from the American Medical Association (AMA)	https://www. stepsforward.org/ modules/ medication-adherence
CDC Everyday Word Guide	https://www.cdc.gov/ other/ pdf/ everydayword 060216-final.pdf
Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator from the American Heart Association	https://tools.acc.org/ Multilingual-ASCVD-Risk Estimator/#!/ calculate/ estimate/

Referencias:

• Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304-14.
• Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001;23:1296-310.
• Gerbino PP, Shoheiber O. Adherence patterns among patients treated with fixed-dose combination versus separate antihypertensive agents. Am J Health Syst Pharm 2007;64:1279-83.
• O’Connor PJ. Improving medication adherence: challenges for physicians, payers, and policy makers. Arch Intern Med 2006;166:1802-4.
• Glynn L, Fahey T. Cardiovascular medication:improving adherence. BMJ Clin Evid 2011;4:220.
• National Council on Patient Information and Education. Accelerating progress in prescription medicine adherence: the adherence action agenda. October 2013.http://www.bemedicinesmart.org/