Identifying Common Adherence Barriers and Providing Personalised Adherence support

define medication adherence

the extent to which the patient’s behaviour matches agreed recommendations from the prescriber

what are barriers to discussing adherence?

• hiding from clinician → not wishing to disappoint or get told off

• defensive in response to direct questioning

• lack of comprehensive discussion → motivational and opportunity factors rarely addressed

what can be used to screen for adherence?

making medicines work for you screener

what are the 8 statements assessed in the MMWFY screening tool?

• my medicine is difficult to use or take

• i can’t manage so many medicines

• i am not sure if the medicine(s) is/are really helping me

• i have some worries about using the medicine

• i sometimes forget to use the medicines

• i can’t afford either the time or the money to get the medicines

• i’ve found my own way to use the medicines that suits me

• do you have any questions/things you’d like to discuss?

how do you set up the conversation about discussing the answers to the MMWFY screening tool?

• permission → can we talk about your answers?

• prioritise → which answer is the most important to talk about today?

• formulate the problem → can you tell me more about why you chose that one?

when do you use the action planning BCT? how does it work?

• when patients forget to take their medication

• promotes habit formation → learnt association between an environmental cue and a behaviour

what are the 6 key steps to the action planning BCT?

• invite patient to explain why they chose to focus on this statement

• explain to the patient that making a specific plan about how to take medication might help them take the medication more regularly

• ask the patient to plan how they might take their medication in a detailed way

• summarise the draft plan in “if when/where then i’ll take my medication” format

• invite patient to evaluate whether the draft plan sounds like it’d work

• asking the patient to record the plan

how can you try to get around the righting reflex?

• ask open questions that encourage the patient to clarify or elaborate

• use empathy and reflective statements

• check understanding by summarising “so if i hear you correctly…”

when do you use problem solving BCT? how does it work?

• used when patients tick the following MMWFY statements:

  • i can’t manage so many medicines

  • i can’t afford the time of money to get my medicines

  • i’ve found my own way to take my medicines that suits me

• works by enabling patient to generate and select options for themselves :. ownership of solution

what are the 5 key steps to the problem solving BCT?

• invite patient to explain why they chose to focus on this statement

• use open-ended questions to understand in depth what factors are getting in the way of patient taking their medication regularly

• use open-ended questions to help the patient identify potential solutions that might help them take their medication regularly

• summarise possible solutions

• invites the patient to choose the solution that they feel will work best for

when do you use the pros and cons BCT? how does it work

• used when patients tick the following MMWFY statements:

  • i’m not sure the medicines are really helping me

  • i have some worries about my medicines

• works by enabling the patient to evaluate the pros and cons of their medicines and make their own judgement about whether to continue

what are the 7 key steps to the pros and cons BCT?

• invite the patient to explain why they chose to focus on this statement

• ask open-ended questions to find out about what the patient thinks are the downsides/”cons” of taking their medication regularly → short and long-term

• ask open-ended questions to find out about what the patient thinks are the benefits/”pros” of taking their medication regularly → short and long-term

• use a summarising statement to bring together all the downsides and benefits

• invite patient to reflect on the summary e.g. what are your thoughts on that?