Improving Medication Adherence: How to Talk With Patients About Their Medications

Medication nonadherence has been shown to have a negative and significant impact on patient outcomes.1 Quality provider communication can have a significant impact on improving patient medication use and other outcomes.2 It remains unclear what specific communication techniques yield the best outcomes on patient adherence. There is a definite need for clinicians to share what techniques work best when helping patients become more adherent to their regimens. 
 
Dr. Shawn Shea's Improving Medication Adherence offers his readers an easy-to-read, humorous description of 43 interviewing techniques that he has either used himself or collected from others he met while giving workshops on interviewing across the country. The techniques are particularly useful when working with a variety of patients who question their medication use. Shea rebukes the terms noncompliance and nonadherence as others have before him by suggesting the term implies physicians make the decisions and patients follow, and provides no description as to why the patient may not follow a prescribed regimen. He introduces a new term and philosophy called medication interest, indicating individuals are on a continuum of interest in taking a medication. Despite his careful selection of this term to replace medication adherence, he still uses the older term in the title of his book, leaving us somewhat uncertain about his commitment to the model. Shea is clear that patients make rational decisions about their interest in taking medications. He often draws on his training as a psychiatrist familiar with schizophrenia by using the metaphor that a patient's decision-making process is like a committee of individuals sitting around a table in the patient's head advocating for and against taking a medication. 
 
The book presents several techniques for how practitioners might respond to better communicate with patients and increase their interest in taking a medication. While the suggested responses guide practitioners on how they might respond to a patient's conflicts about medication use, many of them are long, awkward, and difficult to apply in practice. It is also unclear how many of the techniques directly relate to care provided by pharmacists. Although Shea suggests in the beginning of the book that the techniques can be used by various health professionals including clinical pharmacists, the language of the book seems written mostly from the prescriber's perspective. 
 
The reader of Shea's Improving Medication Adherence should not expect to get much theory or context for the wealth of research done on patient treatment beliefs and behavior. The student of provider-patient communication will note Shea's concepts and techniques are very similar to those used in models and frameworks advanced elsewhere, such as that related to the health belief model,3 motivational interviewing,4 and the value of provider-patient concordance in treatment decision-making.5 
 
The pharmacy educator would most likely not use Shea's book to replace current pharmacy communication texts.6-9 These texts introduce broader concepts in pharmacy communication for a variety of issues and not specifically focused on adherence. Pharmacy educators might purchase Shea's book for themselves so they can provide students other examples of how to frame responses to difficult situations involving medication adherence. If the educator has a significant part of his/her course devoted to adherence, Shea's book might also be considered as a recommended text for student purchase that supplements a required pharmacy communication text. Shea's Improving Medication Adherence is a helpful guide for pharmacy faculty members and students to use when considering additional ways to best frame responses to patients so they are more interested in continuing their medication use.

Field of study: Education, Medicine