Improving Patient Motivation for Medication Adherence

Thursday, October 29th, 2009
This post was written by Melanie Matthews

Connie Commander, past president of the Case Management Society of America and president of Commander’s Premier Consulting Corporation, suggests guidelines to improve patient motivation for medication adherence.

Case management adherence guidelines from the Case Management Society of America (CMSA®) use validated tools to improve adherence. We’ve gotten many variations; some are disease-specific. This tool has concepts presented by the World Health Organization (WHO). The guidelines provide an interaction and management algorithm. We built in some concepts that strive to improve a patient’s knowledge and motivate them to take their medications. That’s how it started, but now it’s grown to the complete treatment plan. If you can get a person to follow the medication regime, you can probably get them to follow the whole treatment plan. The guidelines provide great flexibility so that each patient’s needs can be taken into account.

A WHO white paper on medication adherence in long-term therapies focused on the clinical model and chronic care conditions. It determined that you must have three pillars: information, motivation and behavioral skills. You can rest upon them and get a behavior change. However, without one of them, you won’t get a sustained behavior change. We evaluated tools that were already being studied. We came up with an algorithm to assess patients within the adherence guidelines. The results of the assessment are literacy, knowledge, willingness to change and peer support. We must have those four components, and then we measure the degree of each component. In other words, is the patient’s knowledge or motivation high or low? That tells the case manager the type of intervention that patient needs. Obviously, we’d like to move everyone into a level four where they’re highly motivated and have all the knowledge they need to maintain and take care of themselves. But that doesn’t always happen.

Patients are constantly switching quadrants. There is a way of measuring, and case managers utilize tools to determine if their interventions are working to improve on this algorithm as to the patient’s knowledge or motivation.

Health literacy is defined as the ability to read, understand and act on health information. There are three validated tools currently in use to assess health literacy. They are:

Rapid Estimate of Adult Literacy in Medicine — Revised (REALM-R)
Medication Knowledge Survey
Modified Morisky Scale

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