​One of the hot topics in Health Information Technology (HIT) today centers on medication adherence. According to the latest research, poor medication adherence rates have a negative effect on patient’s health. Additionally, the cost of health care continues to rise because of the overarching effect of poor adherence. There are many reasons that patients do not “adhere” or comply with their medication routines such as cost, lack of insurance, poor continuity of care, chronic conditions, side effects, or perceived benefits of treatment.

According to the American College of Preventive Medicine (ACPM), poor medication adherence is associated with reduced treatment benefits and can obscure the provider’s assessment of therapeutic effectiveness. Nonadherence also:

• Accounts for 30-50 percent of treatment failures
• Leads to worse outcomes
• Accounts for higher hospitalization rates, institutionalization for the frail elderly, and increased healthcare costs

The Centers for Disease Control and Prevention (CDC) and the American College of Preventive Medicine (ACPM) agree that there is an S.I.M.P.L.E. method that can be adopted by providers to combat this issue.

S: Simplify the regimen

• Adjust the timing of the medication; daily dosing is a preferred method for prescribing unless it is cost prohibitive
• Recommend that patient takes all medicine at the same time

Example of Provider/Patient conversation: “I believe that switching you to a once a day medication will be easier to manage. Unfortunately, it will cost a bit more but will provide better control and will provide you with added convenience. Is this an option that you would be willing to consider?”

I: Impart knowledge

• Provide clear instructions (written and verbal); use simple everyday language
• Involve family or friends in the discussion when appropriate

Example of Provider/Patient conversation: “Here is your prescription and here are your written directions. Take two pills twice a day. In starting this new regimen, how will you incorporate these medications into your daily routine?” (Allow patient to repeat back the instructions)

M: Modify patient’s beliefs and human behavior

• Ask patients about their needs. Create an open dialogue with each patient
• Ensure that patients understand they will be at risk if they do not take their medication

Example of Provider/Patient conversation: “Do you have any fears or concerns about the medication I have prescribed?”

P: Provide communication and trust

Modifying patient beliefs is only possible when a high level of patient trust exists. A physician’s communication style is one of the strongest predictors of a patient’s trust in his or her physician. Many physicians are weak in communications. Consider these statistics:

• At least 50 percent of patients leave the office not understanding what they have been told
• Physicians miss 50 percent of psychosocial and psychiatric problems due to poor communication skills
• Physicians interrupt patients on an average of 22 seconds into the patients' descriptions of the presenting problems
• 54 percent of patient problems and 45% of patient concerns are neither elicited by the physician nor disclosed by the patient
• 71 percent of patients cited poor relationships as a reason for their malpractice claims” 

Example of Provider/Patient conversation: “So what I hear you saying is that your stomach hurts only at night.” (Confirm patient message)

L:  Leave the bias

• Learn more about low health literacy and how it affects patient outcomes
• Examine self- efficacy regarding care of ethnically and socially diverse patient populations
• Communication style should be patient centered

Example of Provider/Patient conversation: “Buenos Dias and good morning. Let’s sit down and have a chat.” (Relate to your patient’s demographic)

E. Evaluate adherence

• Self-reports are the most common tool in measuring adherence. Ask patients simply and directly if they are following their drug regimens
• Periodically review patient’s medication containers noting renewal dates

Example of Provider/Patient conversation: “Do you ever forget to take your medications?”

Take-Home Messages for Providers

• Display patience and empathy when interacting with patients
• Be mindful of the number of medications prescribed and their frequency and dosages
• Prescribe lower-cost medications and/or provide manufacturer coupons to help lower costs
• Explain the consequences of non-adherence and suggest ways to improve adherence
• Introduce team-based care to improve medication adherence
• Identify roles and responsibilities in team-based care to deliver improved patient-centered health care