ISU’s Alison Phillips says doctors can prescribe the medication, but don’t often know if the patient is really taking it.
“At most, maybe the intake nurse will say ‘Are you still on these medications?’ but a doctor rarely asks ‘Have you been taking your pills?’ If they do ask they tend to ask directly, which is, ‘In the past week how many pills have you missed?’,” Phillips says. She is an associate professor of psychology and says the direct approach isn’t the best way to get a good answer.
“By research we know that that doesn’t work very well for a couple of reasons,” Phillips says. “It’s an uncomfortable question for doctors to ask, but it’s also an uncomfortable one for patients to answer. They might overestimate their adherence due to something we call social desirability bias. They want to look better.”
Phillips suggests doctors use routine questions to learn more about whether someone is taking their pills.
“Instead doctors could ask, tell me about your medication routine, your habits around taking medication, and from a very brief description could be able to estimate how adherent they are,” according to Phillips. Her research indicates this type of question gives a better idea of what a patient is doing and she says the results are a concern.
“The really rough estimate is about 50 percent of patients are non-adherent to their pretty simple medication regimens. There’s some controversy about exactly what percentage — but it’s enough to be concerned about for sure,” Phillips says.
Phillips says doctors are better at finding out if the patient is taking medication by considering their routines. And she says getting the patients to establish a routine for taking medication is a way to improve their usage.
“People are much more adherent, not only to the day, but to the specific time. And for most medications we want the blood level of that drug to be pretty consistent across the day,” Phillips says. “And so if you take it at the same hour every day it is optimal, for some things it’s actually necessary. Having a habit tied to an existing every day routine is really beneficial.”
Phillips says she plans to build upon the research by designing and testing interventions for doctors to share with patients they identify as less likely to adhere.