Medication Adherence – Heart Healthy Toolbox

For patients, tools include helpful medication tracking tools and information on how to manage multiple medications. Tools for healthcare providers focus on helping patients access the medications they need and strategies to help with medication adherence.

Components

Components are available to download individually or together as the whole section. You can also view all sections of the Heart Healthy Toolbox.

For Patients

• Patient Medication Schedule
• Heart Failure Medicine Management

For Providers

• Medication Adherence Pearls (also available below)

Medication Adherence Pearls

Assess Potential Barriers to Medication Adherence

• Psychological or cognitive impairment
• Side effects
• Lack of patient understanding about their disease
• Loss of insurance, medication cost, co-payments
• Complexity of treatment
• Lack of family, caregiver, or social support
• Lack of understanding around the indications for their regimen
• Lack of clarity around recent changes in medication following a recent hospitalization or provider visit
  • Conflicting medication recommendations among providers
• Language or literacy barrier
• Conflicting obligations (e.g., work schedule, frequent travel)
• Social determinants of health

Clinical Methods to Improve Adherence

Work with Patients and Families

• Utilize shared decision-making and team-based care that engages patient and other members of the healthcare team
• Encourage the presence of a family member, caregiver, or friend at each visit or patient eduction session to support adherence and reduce the risk of error in the home setting
• Utilize teach-back methodology to ensure patient and family member understanding
• Educate patient and family/caregiver about disease and reason for treatment
  • Utilize patient’s preferred language using a translator when indicated.
• Supply patient education sheets, booklets, online interactives about their illness
  • Utilize patient’s preferred language
• Is patient able swallow pills, or is there another method of administration that should be considered?
• Develop a contract for non-adherent patients to improve their role in disease management
• Encourage patients to bring all meds to each appointment—including over-thecounter, herbs, vitamins, supplements
• Encourage self-management to maximize med efficacy and symptom reduction (e.g., dietary or salt restrictions, weight loss, heart rate, blood pressure monitoring, as well as risk of lightheadedness, hold parameters, lab monitoring, and as needed (prn) instructions)

Medication Specifics

• Explain benefits of medications/treatments, as well as potential side effects. If multiple meds are used to treat one disease, educate the patient about the need for each med.
• Provide specifics about when and how to take each med (e.g., “one hour before, or two hours after, meals, with a full glass of water”), and any considerations such as foods to avoid while taking the med
• Decrease cost where possible. Utilize generics, multi-month prescriptions, or even higher dose meds that the patient can cut in half.
• Where possible, simplify med regime using combination pills, transdermal meds, and extended release 1x/daily preparations, if well-tolerated

Tools and Support

• Follow-up by phone with patient to ask about any side effects or difficulties in accessing or managing their medications
• Encourage patient to write down questions and concerns and bring them to each visit
• Encourage use of reminders, pillboxes, calendars, diaries, apps, etc.
• Schedule routine follow-ups. Have a system in place follow-up with patients or reschedule as needed.
• See if pharmacy can provide pill packs or deliveries.

Special Considerations for Elderly Patients

• Begin with low dose and titrate up as tolerated
• Be aware of physiological changes that affect pharmacokinetics
  • gastric motility that may slow oral absorption
  • lean body mass that may lead to a longer half-life of medications including lipophilic drugs
  • hydrophilic drugs increase in half-life due to reduction in total fluid volume
  • decreased albumin production may lead to decreased protein binding and increased free drug
  • decreased GFR and renal clearance may require med adjustment
  • increased risk of side effects and toxicity as body ages
• Are there any psychological problems that would prevent them from taking the med?
• Assess for cognitive impairment. Can the patient read and follow med administration instructions accurately and safely?
• Consider ordering home health service that include an RN for medication management
• Access tools such as The American Geriatrics Society (AGS) Beers Criteria to help ID medications where the risk may be greater than the benefit for the elderly population

Supported by independent educational grants from Merck & Co, Inc. and Novartis Pharmaceuticals Corporation.