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Make the Diagnosis: Compliance and Medication Adherence

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Prior Probability

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Approximately 50% of patients do not take their medications as prescribed.

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Population for Whom Medication Nonadherence Should Be Considered

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  • All patients should be assessed

  • Patients not responding as expected to medication

  • Patients receiving multiple or complicated regimens

  • Patients who miss appointments

  • Older patients

  • Adolescents

  • Patients with cognitive disorders

  • Patients with psychiatric disorders

  • Patients treated for asymptomatic diseases (eg, hypercholesteremia, hypertension)

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Given the high prevalence of medication nonadherence, ask all patients, “Have you missed any pills in the past week?” Any patient who answers yes should be considered nonadherent (Table 15-5). When patients answer no, a negative response to each of the Morisky questions makes it even more likely that the patient is adherent. Questionnaires about adherence may work better than clinical judgment.

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Table Graphic Jump Location
Table 15-5Detecting the Likelihood of Medication Nonadherence
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Reference Standard Tests

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There is no single best reference standard for measuring adherence for all medications, nor is there general agreement for the level of adherence that is considered optimal. Physicians must use their best judgment, tailored to their knowledge of each patient.

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Original Article: Is This Patient Taking the Treatment as Prescribed?

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Clinical Scenarios

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Case 1
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A 28-year-old woman presents to the emergency department in acute distress, with a 3-day history of worsening asthma. Her prescribed medications include an inhaled β2 agonist and an inhaled steroid. When questioned, she breathlessly admits to “occasionally” missing her medications “maybe only once or twice.”

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Case 2
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A 55-year-old man with posttraumatic seizure disorder has been taking phenytoin since his injury. His seizures were initially adequately controlled but he recently has been having weekly seizures. In an office visit he resentfully denies missing any of his medication.

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The Importance of Clinical Examination

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Physicians should measure compliance for patients prescribed a self-administered treatment because noncompliance is common and physicians can help patients improve their compliance1...

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