If you have to put all of your adherence eggs in one basket, then the focus should be on making the act of taking medication a habit—as soon as the prescription is filled.
Patients are non-adherent for a host of reasons. But one of the most common reasons, one that may seem difficult to overcome, is that patients often just forget to take their medication.
And the truth is that this is a tough issue to overcome. A variety of reminder systems—from low-tech calendars and pillboxes to high-tech alarms, text messages and flashing lights—have been used to try to overcome the forgetfulness hurdle. These approaches are somewhat, but not highly, effective at increasing patients’ adherence.
I think the key to overcoming forgetfulness is to make taking medication a habit. Ideally, we want taking medication to be like breathing, something we do without even thinking about it. This is the power of habit (The Power of Habit is also the title of a recent book by Charles Duhigg and is a good book to read for someone interested in the adherence habit).
Consider my parents who take their medication every day. They really do. Every morning, they get up and put their medication in small shot glass in the middle of their breakfast plate. They take the pills as part of a ritual. This ritual is so ingrained in their morning behavior pattern that I think they take their medication without any conscious thought involved. Perhaps the only times they might miss a dose or two is when they are traveling and their usual behavior pattern has been disrupted.
So, how can we get patients to make taking a medication a habit? The first week or two may be critical. This is where I, as a physician, invest my efforts. If I can get patients to adhere to their medications in the first week or two of treatment, then hopefully they will discover that the medication works and will establish a pattern of treatment that will continue well into the future.
It is for this reason that I will have patients follow up with me in just a week or two after starting treatment rather than after six or eight weeks. The office visit drives adherence to treatment, and there’s no added cost (it’s one return visit, just a question of whether it is sooner, which promotes adherence, or later, which doesn’t).
When we think of how to invest our adherence resources, I think focusing on the time right around when the prescription is given is key. Doing so will promote getting patients to fill their prescription and may establish a pattern of long-term, regular, habitual adherence.