Simplify Adherence by Identifying Patient Intentions

By | February 12, 2014

Progress to improve adherence has been frustratingly slow. Maybe there are just too many options and too much information; making understanding and interpretation difficult? We need to simplify adherence in order to make the breakthroughs needed. Identifying patient intentions can help achieve this.

Too Many Pieces in the Adherence Puzzle?

Improvements in adherence have been difficult to achieve and progress has been frustratingly slow. To what extent is this lack of progress a product of too much information? That’s a question I’ve been exploring in recent posts.

There are so many ‘moving parts’ in the adherence puzzle, it’s hard to make sense of it all. Plus, it’s tough to translate all the data into practical actions relevant to day-to-day clinical practice. In short, maybe there’s just too much ‘adherence clutter’ (see here)?

To make better progress we must simplify adherence. This can be done by reducing the number of ‘moving parts’. Say for example, we separate out the ‘necessary’ pieces from the ‘unnecessary’ (ie, the ‘clutter’). That’s a common approach to solving complex problems.

A previous post (see here) suggested how this may be done for HCPs; by aligning selected adherence interventions with their priority needs. Now in this post, we’ll take a similar approach with patients.

Simplify Adherence by Focusing on Patient Intents

Simplify Adherence by Cutting Through the Clutter

Simplify Adherence by Cutting Through the Clutter

“Patients are all different.” That seems to be the current governing theory. They have different reasons for non-adherence, which require different adherence interventions. As a theory, this may be true. However in practice such an approach may be just too complicated to work. The many pressures on HCPs’ time limit their ability to handle multiple different intervention types.

So is there another way to look at the patient side of things that can help simplify adherence interventions? How about if we distinguish between “verbalized” and “hidden” reasons for non-adherence?

By “verbalized”, I mean all the reasons that patients willingly offer for why they don’t adhere to treatment. These reasons are too many to list out here, but include things like: I don’t understand; too expensive; too complicated; I forgot; etc.

By “hidden”, I’m referring the reasons for non-adherence that patients most often don’t willingly share. Examples of such reasons may include: I choose not to adhere; I’m not motivated; etc.

This second category describes intentional non-adherence, which has been reported in over 40% of chronic medication patients (see here). It occurs frequently and deserves special attention. Especially as “not being motivated” to adhere likely has major knock-on effects on compliance with interventions for verbalized reasons too!

Here is one large group of non-adherent patients with a common issue – lack of motivation. A prime target for adherence simpification.

Simplify Adherence through Improving Patient Motivation

When patients aren’t motivated to change their behavior, they are much less likely to respond to standard adherence interventions such as simplification, education, cost reduction, or reminders. So for non-adherent patients, perhaps motivation should be the first thing to assess? Also, maybe improving motivation should be the first intervention to consider?

There are proven interventions for improving adherence motivation; for example motivational interviewing and gaming/behavioral economics. Can using such interventions first help simplify adherence? And more importantly help achieve that elusive goal of improving adherence.

Addressing motivation may be one broadly applicable approach to help simplify adherence. What about others? Any thoughts?