Pearls

Promote medication adherence, one stage at a time

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References

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.

Table

Assessing readiness to start medication

Stage of change2Patient statementSuggested interventions
PrecontemplationI 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
ContemplationI 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
PreparationI 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
ActionI am ready to take the medication as directed
  • Encourage the patient to keep a record of times medication is taken and changes in symptoms

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