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Promote medication adherence, one stage at a time

Vol. 4, No. 8 / August 2005

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

Patient statement

Suggested interventions


I do not intend to take the medication as directed

  • Provide information about the medication’s action
  • Have the patient list benefits of taking the medication
  • Ask the patient to identify concerns, such as side effects, and openly address them with the patient


I intend to take the medication as directed, but not right now

  • Have the patient list the positives and negatives of taking the medication
  • Suggest other benefits to add to the list
  • Provide options to counter the negatives


I plan to take the medication as directed in the near future

  • Ask the patient what she or he needs to begin
  • Ask the patient to set a date for starting medication


I am ready to take the medication as directed

  • Encourage the patient to keep a record of times medication is taken and changes in symptoms


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.

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