What follow‑up medication‑management questions should I ask?

Follow-Up Medication Management Questions

Ask patients directly about medication-taking patterns using specific, non-judgmental questions that trace backward from the most recent dose to identify patterns of nonadherence and barriers to adherence. 1

Core Assessment Questions

Medication-Taking Behavior

• "Did you take your morning dose today?" Then trace backward to yesterday evening, yesterday morning, and the previous week 1
• "How many doses did you miss in the past week?" This simple question serves as an appropriate starting point for adherence assessment 1
• "Please show me how you use your inhaled medications" (or other devices requiring technique) 1
• "What medications are you taking? How and when are you taking them?" 1

Identifying Barriers and Patterns

• "What problems have you had using your medications?" 1
• "I understand it is very difficult to take all medications as prescribed; have you been able to take any this week?" This phrasing facilitates honest reporting rather than incriminating patients 1
• Ask about specific difficulties: child resistance (for pediatric patients), work schedule conflicts, caretaking responsibilities for other family members, caregiver's own ill health, attempts to avoid thinking about the illness 1
• Identify patterns of nonadherence: always missing the morning dose, missing doses on weekends, missing doses during specific life circumstances 1

Caregiver and Support System Assessment

• "Who helps you take your medications?" Elicit information about babysitting arrangements and methods used by caregivers to remind others of medication-taking needs 1
• Ask about disclosure: Has diagnosis been disclosed to temporary caregivers who may need to administer medications? 1

Treatment Response and Safety Monitoring

Benefits Assessment

• "What do you want to be able to do that you can't do now because of your condition?" 1
• Assess functional improvement: Use validated tools like the PEG scale (Pain average, interference with Enjoyment of life, interference with General activity) or ask about progress toward specific functional goals 1
• "Are you able to do the activities that matter to you?" 1

Adverse Effects Screening

• Ask about common adverse effects: constipation, drowsiness, dry mouth, weakness/exhaustion/fatigue, reduced alertness, sleep disturbances 1
• Screen for early warning signs of serious problems: sedation, slurred speech (overdose risk); craving, wanting to take medications in greater quantities or more frequently than prescribed, difficulty controlling use (opioid use disorder) 1
• Monitor for nonspecific symptoms: motor disorders, tremors, falls, diarrhea, incontinence, loss of appetite, nausea, skin rashes, itching, depression, confusion, hallucinations, fear and agitation, vertigo, tinnitus 1

Patient Preferences

• "What do you expect from treatment?" 1
• "Do you want to continue taking these medications, given their effects on your symptoms relative to any side effects you've experienced?" 1
• "What are your treatment preferences?" 1

Medication Appropriateness Review

Ongoing Need Assessment

• "Do your medications continue to help you meet your treatment goals?" 1
• Determine if nonadherence is confined to a particular drug or exists across medications 1
• "Are there medications you feel you no longer need?" 1

Safety Concerns

• Review for drug-drug interactions, particularly with new medications 1, 2
• Check for duplication in therapy 2
• Verify appropriate dose, route, and schedule 2
• Screen for concurrent use of other CNS depressants (benzodiazepines, alcohol, cannabis) when patients are on opioids 3

Environmental and Comorbidity Assessment

Trigger Identification

• "Are there things in your environment that make your condition worse?" 1
• For asthma patients: Assess exposure to tobacco smoke, allergens, and irritants 1

Comorbid Conditions

• Screen for conditions that may impede management Recognition and treatment of comorbidities may improve overall control 1

Critical Timing Considerations

High-Risk Periods Requiring Enhanced Monitoring

• Within 1-4 weeks of starting long-term therapy or dose escalation 1
• Within 3 days when starting or increasing methadone 1
• Within 1 week when starting or increasing other ER/LA opioids 1
• At least every 3 months for all patients on long-term therapy 1
• More frequently than every 3 months for high-risk patients (those with depression, substance use disorder history, taking ≥50 MME/day, or taking other CNS depressants) 1

Common Pitfalls to Avoid

• Never use incriminating language such as "We have talked about how important good adherence is. You have not missed any doses lately have you?" 1
• Maintain a nonjudgmental attitude throughout Statements acknowledging difficulty in taking all doses are crucial 1
• Interview both patient and caregiver separately when applicable, then reconcile discrepant reports 1
• Remember that adherence is dynamic and lifelong Crises, new jobs, caregiver illness, new relationships, different babysitters, loss of housing can all affect medication-taking 1
• Assess adherence at every visit as part of a structured monitoring program to identify nonadherence early 1

Documentation Requirements

• Record specific medication-taking patterns identified 1
• Document barriers to adherence and interventions planned 1
• Note functional status and treatment goal attainment 1
• Include adverse effects reported and clinical parameters monitored 1