3 Steps to Better Medication Management

Information, motivation, and strategy are top priorities for adherence counseling, according to a new study.

Medication nonadherence costs the US health care system between $290 billion and $300 billion each year. To address this growing problem, a team of behavioral researchers has developed a new counseling model that promises to improve adherence by addressing 3 key factors that prevent patients from taking their medicines as directed.

Called the “Information-Motivation-Strategy (IMS) Model,” the tool was created using findings from a meta-analysis of more than 100 large-scale adherence studies conducted between 1948 and 2009. An article on the model appears in the Spring 2011 issue of the Health Psychology Review, a journal of the European Health Psychology Society.

The model’s creators note that even physicians' best efforts to guide patients toward adherence are thwarted by a fundamental communication gap.

“Patients often misunderstand the value of following medical recommendations accurately and physicians often overestimate patient adherence or cannot determine which patients are having adherence difficulties,” said lead author Robin DiMatteo, PhD, a professor and adherence researcher at the University of California Riverside.

Dr. DiMatteo’s model aims to close that gap with a systematic, 3-pronged approach to helping patients manage their medications:

1. Information. Patients often lack the health literacy skills needed to interpret information provided to them by physicians. Counseling for adherence should encourage patients to be active participants in their care, rather than passive listeners. This can be achieved by asking questions about why and how they will adhere to treatment recommendations and listening carefully for any signs of misunderstanding or confusion.

2. Motivation. Previous research has shown that beliefs are a major driver of nonadherence. According to the study, health care professionals should “help patients to believe in the efficacy of treatment” and “believe that they are capable of doing it.” For pharmacists, this may also require understanding a particular patient’s cultural background and whether it conflicts with a prescriber’s recommendations.

3. Strategy. When combined with the more subjective factors described, practical barriers to obtaining or taking medications can be the last straw for patients. A patient who can’t afford treatment or drive to appointments or the local pharmacy is unlikely to adhere. Complex regimens are also a strategic barrier that must be addressed, either by electronic reminders or follow-up calls to help patients remember to take their medications as prescribed.

The study’s authors say the IMS Model is unique among adherence solutions because it focuses on building a trusting, mutually beneficial relationship between patients and their health care practitioners.

“Nonadherence is a complex problem, and addressing it requires the efforts of both patients and clinicians, as well as all members of the health care team and the individuals who are part of patients’ lives,” they wrote.

For other articles in this issue, see:

• Errors Lurk in Switch to e-Prescribing
• "Polypill" Shows Promise for Heart Patients