Promote medication adherence, one stage at a time
Almost one-half of patients prescribed psychotropics do not take recommended dosages, but interrogating them can make them defensive and compromise your therapeutic alliance. When a patient resists starting a psychotropic, targeted interventions tied to a medication-specific transtheoretical approach can help.
Stages of change
Willey et al1 validated Prochaska and DiClemente’s stages of change2 for patients prescribed medications. Their modification provides quick assessment of how ready a patient is to commit to taking medication.
If your patient does not start a psychotropic, acknowledge that some find it difficult to take medication as directed. After you determine the patient’s stage of change, I suggest that you tailor interventions to match that level (Table), then work toward the action stage: commitment to adherence.
With stage-specific interventions, patients feel empowered to make their own decisions, rather than coerced or pressured to take medications.
Assessing readiness to start medication
Stage of change2
I do not intend to take the medication as directed
I intend to take the medication as directed, but not right now
I plan to take the medication as directed in the near future
I am ready to take the medication as directed
1. Willey C, Redding C, Stafford J, et al. Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure. Clin Ther 2000;22(7):858-71.
2. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward and integrative model of change. J Cosult Clin Psychol 1983;51:390-5.
Deborah S. Finnell, is a board-certified nurse practitioner in psychiatric mental health nursing and addictions nursing at Canandaigua VA Medical Center and assistant professor of nursing, State University of New York, Buffalo.