Experts will discuss strategies to improve treatment adherence

Treatment adherence is and always has been a problem. The gap between prescribing a pharmacologic or nonpharmacologic intervention and what the patient actually does can be enormous.

“A treatment can only provide the benefits you expect if the patient is actually adherent,” said Maura Daly Iversen, PT, MPH, DSc, DPT, Dean of the College of Health Professions, Professor of Public Health, and Professor of Physical Therapy and Human Movement Science at Sacred Heart University, and Behavioral Scientist in Rheumatology, Immunology and Immunity at Brigham & Women’s Hospital. “It doesn’t matter whether you’re talking about pharmacologic interventions or nonpharmacologic interventions such as exercise and physical activity — you put a lot of time, effort, energy, and expertise into selecting treatment. Without adherence, patients will never gain the benefits you and they expect.”

Dr. Iversen will discuss strategies to improve adherence to arthritis therapy during the session Adherence: Tools for Treatment Success, which will be held from 11 a.m. – 12 p.m. ET Saturday, Nov. 6. The session also will be available on demand for registered meeting participants through March 11, 2022.

Kamala M. Nola, MS, PharmD, Professor and Chair of Pharmacy Practice at Lipscomb College of Pharmacy, will discuss frequency of dosing, timing, life stage, and other external obstacles to medication adherence during the session.

“We know that once-a-day dosing is always better than multiple doses every day. When you increase dosing to two, three, four times daily, adherence declines,” Dr. Nola said. “The goal is always to make the regimen as simple as possible, but you also have to integrate adherence into the patient’s lifestyle. Is it easier for them to take something in the morning or evening? And how does that work in relation to when the medication itself is more effective? Improving adherence can take a lot of communication and strategizing between the patient and the pharmacist.”

One key to improving adherence is adapting to each patient’s attitudes and behavioral skills, Dr. Iversen added. Some patients are self-motivated, can set goals, and use incremental changes to achieve their goals. Other patients need someone to remind them when it’s time for the next dose or time to exercise. That someone could be a nurse at an infusion clinic calling with an appointment reminder, or a spouse or companion who can help keep track of medication timing or activity schedules. It could even be an app.

“The real crux of improving adherence is creating a strategy that is built on the personality type of the individual,” Dr. Iversen said. “Different personalities are more amenable to different types of adherence strategies. And there are screening tools that can help you tease out the approach that might be more effective to help that particular individual meet their goals for treatment.”

Age and lifestyle matter, too, Dr. Nola added. Pediatric patients likely rely on a parent for adherence. But as children age into adolescence, most want more responsibility and control. Except for those teenagers who don’t want to appear different from their peers, which can make adherence an issue.

“Adherence is one of the things that keeps me up at night,” Dr. Nola said. “The costs associated with poor adherence are significant, not just to the patient but to the whole healthcare system. Adherence is a problem we need to fix.”