Three Tools to Assess Medication Adherence

Tuesday, January 5th, 2010
This post was written by Melanie Matthews

Connie Commander, president of Commander’s Premier Consulting Corporation and immediate past president of the Case Management Society of America, discusses three assessment tools that physicians should use to improve medication adherence in patients.

Three validated assessment tools for medication adherence are the Rapid Estimate of Adult Literacy in Medicine – Revised (REALM-R), the Medication Knowledge Survey and the Modified Morisky Scale.

The REALM-R tool is a simple, brief, eight-item screening tool in which you ask the patient to read the words to you listed on the tool’s record. From those results you can determine if they’re able to read them correctly. You’re looking for their ability to pronounce the words appropriately — not for them to define them or use them in a sentence correctly. The first three — fat, flu and pill — are to get the patient started. After that, an example is “allergic.” Do they say “allergies” rather than “allergic?” If so, they would not get a point for that. Also, if they said “anemic” rather than “anemia,” there’s no point. That’s how you utilize this tool. The patient scores give the case manager or caregiver an idea of whether they’ll struggle. I often tell case managers to never think that intelligence quotient (IQ) is related to health literacy. It’s not. You can have a Fortune 500 CEO who is very highly educated but cannot understand anything regarding a diagnosis for themselves or their family member. Therefore, this tool will give you an idea of an individual’s health literacy level.

The Medication Knowledge Survey tool looks at the medication the patient is taking and what they know about the medication. We can learn many things from the medication knowledge assessment form. Where do they keep the medication? Do they know if it needs to get refilled? Do they know the pros and cons of taking the medicine? Do they know the name of it? We find that they may know some of this — but not all of it. They may put the medication away somewhere or take it once a day rather than once a week. From the case management perspective, this is another important tool to tell us what we need to do with the patient.

Once you’ve got someone following a treatment plan, you use a Modified Morisky Scale for existing therapy. It’s a check and balance of where they are with knowledge and motivation and allows them to be categorized as either high or low. Some questions are:

Do you ever forget to take your medicine?
When you feel better, do you sometimes stop taking your medicine?
Do you sometimes forget to refill your prescription?

I tell caregivers to be careful about refills. Often patients get medical supplies from the physician, so they don’t need to refill it for a while. Again, the patient’s answers give you an idea of where you go next with your case management intervention.

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