Tip of the Week: Promote Adherence Among Vulnerable Populations

Promoting medication adherence is among the key responsibilities of pharmacists and technicians. Medication nonadherence varies across patients depending on their disease or condition, the number of medications they take, the adverse effect profile of those medications, the route of administration, the patient’s cognitive function, level of social support, and a host of other factors.

Paramount in this regard is promoting adherence among patients who might be most vulnerable and for whom medication-taking might be especially challenging. This includes patients with mental illness and those who are homeless. Patients with mental illness often require considerable social support to be adherent, while homeless individuals often have difficulty gaining access into the system, paying for their medications, storing them, and keeping track of needed refills.

These issues were further explored by researcher Tyler Watson, MSc, and his colleagues, who conducted interviews of purposively selected patients to elicit information on medication-taking strategies and the potential use of mobile technology to support adherence.¹ Patient enrollees were acquired from a community-based outreach program that provides immediate access to housing with treatment and services intended to help reintegrate them back into society and establish long-term housing.

Several themes emerged from the interview data. One was patient-related factors, and particularly their learned coping strategies and attitudes toward medications. Coping strategies such as establishing regular routines and avoiding risky situation or triggers were important in enabling adherence. This included timing medication with meals, even if the mealtimes were irregular.1 Patients with a history of substance abuse also indicated that they attempt to avoid places where drugs are sold.¹

Patients with better adherence rates were those more likely to be concerned with maintaining control in their lives. Another factor, external influences, described the impact of family and friends, peers, and health team supports. Adherence aids provided by the pharmacy were important, such as medications in blister packs.¹

The ability to remain connected to various support systems, a third factor, was also important. Several of the participants, including some of the homeless patients, had a mobile phone, although others avoided a mobile phone to avoid potentially risky behaviors. Of course, costs were a factor in others not owning a mobile phone, while others noted that their phones were frequently stolen. The study participants largely were not using apps and text messaging to support adherence, but much of this was due to a lack of knowledge about such technology, and many of them indicated much favor with the potential.¹

The study underscores the fact that when people feel in control of their lives, they are much more likely to engage in positive health behaviors. Pharmacy personnel can do much more than they might think to help patients cope and to empower them to feel as though they have greater control of their own lives. Moreover, talking with these patients develops one’s own empathy toward them and helps humanize them, as well as promote those patients’ own self-worth and self-efficacy. Sometimes just a small boost of any kind can help patients cope and potentiate their ability overcome barriers. Pharmacy managers can make a special effort that not only they, but their entire staff take just a few moments of time for the most vulnerable among us.

Additional information about Creating and Managing Value and Managing Technology that Supports the Medication Use Process can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

ABOUT THE AUTHOR

Shane P. Desselle, PhD, RPh, FAPhA, is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy.

REFERENCE

Watson T, Schindel TJ, Simpson SH, Hughes CA. Medication adherence in patients with mental illness and recent homelessness: contributing factors and perceptions on mobile technology use. Intl J Pharm Pract. 2020;8(4):362-369.