For a long time I have been interested in what we usually call medication
adherence which basically means how well you take your medication as prescribed by your
physician. And medication adherence often comes down to having a really good plan of
action. To plan exactly what s your medication for, you have integrate what your medication
is for, you have to integrate information about your medication- what is it for? How
often do you have to take them? Can you take one medication with another medication? Should
you take them with or without food? All of those constraints associated with multiple
medications have to be integrated with each other and the planning is usually more successful
if you also integrate that information into what you know about your daily routine- so,
when do I wake up? When do I eat my meals? How should I arrange my schedule taking medication
around my daily routine? That's likely to lead to a more concrete, easy to implement
plan that would lead to medication adherence. Medication adherence is a particular issue
for older adults because, in general, as we age, we re more likely to get chronic illnesses
like diabetes and hypertension and because of that, our physicians subscribe more and
more medications to treat the symptoms, for example. It s not uncommon for statistics
suggest that one in four adults over the age 65 are taking at least 5 medications, 10%
of older adults are taking 10 or more. So it's a very demanding task, it's a very cognitively
demanding task. You have to be able to integrate all that information into a concrete plan.
We know it's challenging for older adults because statistics suggest that as many as
half of older adults with chronic illnesses aren't taking their meds they way they should.
Sometimes that threatens their safety so they end up in the hospital because they're taking
the wrong combination of drugs. If nothing else, not taking them medications when
you're supposed to reduces the efficacy of the treatment. So, it s a cognitively demanding
task for older adults. Ideally, they get help with the planning part of taking medication
by interacting with their providers; the providers are the ones who know the most about medication.
So, ideally you ve got the providers who are educating a physician or a nurse, is educating
the patient about what their medications are for, when they should take them, kind of provide
that information about the medications, helps the patient make decisions and plan about
how they integrate that information into their daily routine. So that they jointly come up
with a plan that the patient can them come home with to guide the task of taking medication.
Unfortunately, the ideal is often not met in the health care system, providers may not
provide the information they should; there may not be the discussions that should go
on; providers may not check comprehension of the information they do present; they may
not be well organized; so, there is a basic issue of whether patients are getting the
support-educational collaborative support- from nurses and physicians. This is not surprising
because there's limited time in an office visit to do this kind of collaboration. Providers
may not be trained in efficient and easy to use strategies for supporting collaboration.
So with that kind of background of why medication adherence is important and the importance
of collaboration between patients and providers, we've been trying to develop aids or tools
for helping to increase the efficiency of patients and providers working together to
create a plan.
We've developed what I call a Med Table, which again it's a very simple, paper-based tool to promote collaboration.
It's a medication table; it organizes medication information with the patients-the information
of the patient's routine. We try to structure it so that it helps the patient think about
the information they need to take their medication and also to encourage patients and providers
to work together to develop a concrete plan; so that the provider, say the nurse, provides
the medication information, writes the information down on the medication table. The patient
may write down their typical routine, when they get up, when they eat breakfast. The
paper med table provides an external work space for them to combine those constraints
from the medications and from their daily routine, the patient's routine, in order to
come up with a schedule. Basically, filling out the cells of the table, indicating when
they should take their medication. I think it's really important that the patient be
actively involved in jointly creating the schedule for a couple of reasons for a couple
of reasons. By being actively involved when they listen and see the information, it's
likely to improve their comprehension of the information, to the extent that they're thinking
about and adding information about their schedule that also will help them improve their memory
for the information. And really, in filling out this schedule, they re thinking concretely
about when and where they're going to take their medications. There's even evidence that
suggests that they'll remember to do so at the right time. So the table encourages collaboration,
it provides cognitive benefits for the patients at home because of the interaction that's
going on, and it also helps the provider do things like check patient comprehension; so
they can look at the table and see if it's being checked and being filled out and they
can see how well the patient's thinking about things. That provides them the opportunity
to maybe tweak the schedule so it's more optimal, given what they know about the medication.
So ideally, the patient and provider, during a clinic visit, will fill this out and the
patient should take home a copy of it because that's important, so that they can use it
as a reference when they take their medications. But the interaction between the patients and
the providers provides a lot of benefits itself in terms of having these two people come up
with a plan of action that makes sense. So the next step, is to go into an actual primary
care setting and have patients and providers work together to see if these tools help them.
With my colleagues, my medical colleagues at Peoria, we ve had a small number of chronically
ill older adults taking a lot of medications, I think on average 9 medications each, not
very well-educated older adults. So now we re introducing issues- not just age-related
declines of say working memory- but basic literacy issues. So we have these kinds of
adults sit down with an actual pharmacist or nurse and fill out a paper med table representing
their actual schedule. This is not hypothetical. It's their actual schedule. So far what
we've done, after the patient has worked with the provider with a med table, we just ask
them questions. Is this easy to do? Would this be useful if you did this every time
you came in to see your provider? And very enthusiastic, the endorsement of the experience,
the people in this little study thought that it helps organize the way they think about
taking their medication and having the med table filled out at home would be a great
reference to use.