Nurses and NPs Can Do More to Improve Adherence

By | October 29, 2013

Efforts to improve patient adherence are making slow progress. Could nurses and NPs be key factors in accelerating adherence improvements? This post explores reasons why physician practices should look urgently at this option.

Nurses Are Well Qualified to Improve Adherence, But Are Underused

With over 3 million members, nurses are the largest group in the healthcare workforce. Nurses are increasingly well qualified (see here: “Focus on Education”), with 50% or more holding a bachelor’s degree or higher. They feature in almost every aspect of healthcare delivery, including hospitals, primary care practices, case management, and health plans. Depending on their scope of work, nurse practitioners (NPs) may also diagnose and treat patients.

Physicians are too overburdened with administrative tasks to effectively improve adherenceAs physicians are increasingly burdened by administrative tasks, they are spending less time with patients. This limits a doctor’s ability to effectively identify the motivations associated with medication non-adherence. It may also limit their ability to counsel patients on ways to improve adherence. Adding to this, there is the growing shortage of physicians, particularly in primary care.

These physician trends are leaving a large and important ‘gap’ in care. Specifically a gap in the ability of physician practices to adequately monitor patients’ adherence and to adequately manage and treat poor adherence.

Nurses and NPs are particularly well suited to fill these roles, yet at present they are underused. Making better use of nurses and NPs to improve adherence can improve patients’ health and also reduce healthcare costs.

Nurses Have the Skills to Improve Adherence

Nurses and NPs have the skills and aptitude to improve adherence through developing strong personal relationships with patients. Here’s a “5-for-Success” list of reasons why they should take more active roles in managing and improving medication adherence:

Patient trust and relationships – In Gallup surveys, nurses have consistently been rated highest for honesty among healthcare professionals. And of course honesty is a key factor in generating trust and building personal relationships. In turn, a trusting relationship is a big stepping stone towards better patient adherence.

Patient communication and engagement – Nurses spend time communicating with patients, because they care and because the patient comes first. They get to know the patient at a personal level — their fears, their thoughts, and their preferences (see here). This knowledge helps in tailoring treatment to an individual patient’s needs. Aside from further strengthening personal relationships, good communications and patient engagement are also strongly associated with better adherence.

Patient education – Nurses are often good patient educators. They have a good working understanding of medical conditions and treatments. Plus they can explain them in language easy for patients to understand. Understanding the right information helps build the right patient beliefs, which helps improve adherence.

Patient motivation – Motivating patients to adjust or make changes to their behavior is a common nursing challenge. Medication adherence is often a case in point. The validation of motivational interviewing (MI) to improve adherence provides nurses with a valuable tool to help achieve these behavioral changes. MI is easy for nurses to include into patient discussions as it typically takes only a brief time (eg, 10-to-15-minutes).

Nurse experiences – Studies have shown that nurses and NPs have successfully been able to improve adherence in a number of different situations. For example through:

  • Telephone follow-ups with patients
  • Implementing work site interventions
  • Home visits with patients
  • In-clinic discussions with patients
  • Education and counseling of patients prior to hospital discharge

All of which is neatly summarized in the following line from a recent article:

Nurses can make a significant difference in patients’ understanding about their medications and their willingness to take the drugs as directed.

Physicians are overburdened with administrative tasks, so the time is right for nurses and NPs to step up and help improve adherenceNurses and Adherence – the Time is Right

Three years ago the Institute of Medicine published their directional report: “The Future of Nursing: Leading Change, Advancing Health”. This report advocated that nurses and NPs should practice to the full extent of their education and training.

Nurses are ready and able to take on bigger roles in the battle to improve adherence. They should lobby hard for such roles. And if physicians have any sense, nurses should be granted these roles right now!

Your thoughts?