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 change2 | Patient statement | Suggested interventions |
---|---|---|
Precontemplation | I do not intend to take the medication as directed |
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Contemplation | I intend to take the medication as directed, but not right now |
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Preparation | I plan to take the medication as directed in the near future |
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Action | I am ready to take the medication as directed |
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