From the Guidelines
I strongly recommend a social work and/or psychology consultation to develop a comprehensive adherence plan for this patient, as it is crucial for improving long-term health outcomes by addressing complex psychosocial factors that may interfere with treatment adherence. The consultation should be arranged promptly to establish a supportive framework for medication and treatment compliance. According to the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1, a patient-centered approach that considers the patient's perspective, simplifies medication regimens, and addresses costs and access can improve adherence. The social worker or psychologist can assess barriers to adherence, including psychological factors, social determinants, financial constraints, and health literacy issues, and implement targeted interventions such as motivational interviewing, cognitive behavioral therapy techniques, or connection to community resources. Regular follow-up sessions should be scheduled, initially more frequently (perhaps weekly or biweekly), then adjusting based on progress. This approach is supported by the EASL clinical practice guidelines: liver transplantation, which recommends social, psychological, and psychiatric evaluation to evaluate adherence and potential risk factors for non-adherence after liver transplantation 1. However, the more recent and higher-quality study by the American College of Cardiology 1 provides a more comprehensive framework for improving adherence, emphasizing the importance of a patient-centered approach and the use of decision aids, education, and behavioral supports to promote adherence.
Some key considerations for the social work and/or psychology consultation include:
- Assessing the patient's goals and values to inform the development of a personalized adherence plan
- Identifying and addressing potential barriers to adherence, such as depression, anxiety, or substance use
- Providing education and support to promote health literacy and self-management skills
- Facilitating access to community resources and services to support adherence and overall well-being
- Monitoring progress and adjusting the adherence plan as needed to ensure optimal outcomes.
By prioritizing a patient-centered approach and addressing the complex psychosocial factors that influence adherence, we can improve long-term health outcomes and reduce the risk of non-adherence and its associated consequences.
From the Research
Evaluation and Treatment Recommendations
The recommendation for social work/psych consult may be helpful for long-term adherence planning is supported by several studies.
- A study published in 2014 2 found that complex interventions with multiple components, including tailored ongoing support from allied health professionals, can improve medication adherence.
- Another study published in 2020 3 highlighted the importance of interaction with a health professional in promoting adherence and understanding the reasons for non-adherence.
- A review of interventions to improve medication adherence published in 2018 4 identified six categories of interventions, including patient education, medication regimen management, and clinical pharmacist consultation, which can be effective in improving adherence.
Key Factors in Medication Adherence
Several factors can affect medication adherence, including:
- Patient-related factors such as health literacy and involvement in treatment decision-making 5
- Physician-related factors such as prescription of complex drug regimens and communication barriers 5
- Health care system-related factors such as office visit time limitations and limited access to care 5
- A study published in 2021 6 found that unintentional non-adherence, such as forgetting to take medications or running out of medications, is a common issue among patients with chronic illnesses.
Strategies for Improving Medication Adherence
Several strategies can be used to improve medication adherence, including:
- Using combination pills to reduce daily pill burden 4
- Clinical pharmacist consultation for disease co-management 4
- Medication-taking reminders such as telephone calls to prompt refills 4
- Patient education and counseling 4
- A study published in 2011 5 suggested that multifactorial solutions are needed to address the complex and varied barriers to medication adherence.