Adherence is Overrated

When a patient walks into a pharmacy and says they are having trouble remembering to take a medication, there are problems that arise when determining the degree of nonadherence. First of all, patients will undoubtedly underestimate the amount of times the have missed their medication. In addition, if a patient is not stating any issues with adherence, pharmacists can only truly observe refill behavior to monitor adherence. Only the date the prescription is filled can be recorded, so often monitoring adherence can be difficult.

But here is why Dr. Crowe, PharmD, is stating that adherence is “overrated” – patients can be perfectly adherent, never missing a single dose and still experience ineffective drug therapy. Dr. Crowe feels that the focus of pharmacists should lie on making sure the drug therapy regimen is efficacious, no matter the adherence of the patient. Because pharmacists see patients several times in between visits with their physician, they can be the one to monitor symptoms and side effects in between the visits. Dr. Crowe states that this is important because “when patients hold up their end of the adherence bargain, they [should be] doing so with an effective medication.” He uses the example of multiple sclerosis (MS) and how pharmacists can not only monitor the symptoms, but the relapse frequency. If this frequency becomes too high, they can recommend a switch in therapy.

This is a great concept that I have never thought of before in the way that was described by the article. It makes sense that if patients are doing everything they should be, they should be getting the best possible benefits from their medication. As far as monitoring symptoms to check for medication efficacy, I immediately thought of antidepressant medications. Because they take several weeks to work, it would be helpful for the pharmacist to check in on the patient when they are refilling a prescription to see how their mood has improved. If there is no improvement after one or two refills, they can contact the physician to recommend a change in therapy. I hope that this mentality is one that every pharmacist uses or is introduced to during their career, in addition to monitoring adherence.

Crowe, Michael. “Adherence is Overrated.” Pharmacy Today. 21.7 (1 July 2015). 63. Web. 17 February 2016.

5 thoughts on “Adherence is Overrated”

  1. I agree that a patient should be given the most effective possible drug for them. However, I question how we as pharmacists can know if the drug is effective is there is not adherence. If the patient is not taking the medication, it might appear ineffective when it has the possibility to do the most good for them.

  2. I think that this article makes a great point. Pharmacists are the most accessible of all health care providers, so it only makes sense that we would check in on our patients to be certain that their therapy is working. However, I do agree with the previous commentator. The only way to truly know if a med is working is to take it. A patient can’t take an antidepressant intermittently and expect it to work. All in all, I think that it should be a pharmacist’s job to ensure that the patient understands how important adherence is before pursuing changes.

  3. I thought this article was very interesting. I agree with Dr. Crowe that pharmacists should be concerned about making sure that a patient’s medication is efficacious. However, I think it is of equal importance that pharmacists make sure that a patient is adherent to his or her medication. To truly know if a medication is producing the desired outcome, the patient must be taking the medication in the manner in which it was prescribed. Medications are most effective whenever they are taken adherently. Therefore, in my opinion, medication adherence and medication efficacy go hand in hand.

  4. I thought the title of this post was very bold. Yes, I agree that the patient needs to be on the most efficacious medications possible but I think calling adherence “overrated” is nonsense. I do understand Dr. Crowe’s point, but, I think that the pharmacist’s focus should be on both adherence and efficacy. If the patient is on the most efficacious medications but not taking them, then we will not see optimal outcomes. I do not agree that efficacy should be the “main focus” of pharmacists because I think adherence and efficacy are equally important.

    1. While I did not come up with the title, I thought it served the purpose of a title in the best way possible. It caught your eye and was interesting enough to capture your attention. As pharmacy students, we learn the importance of adherence from day one and to see an article written by a pharmacist that says the opposite is what made you read the article. While I do also feel that adherence is equally as important as efficacy, I support Dr. Crowe’s choice of title for this article. It is indeed very bold, has gotten the attention of many, and his idea is now more well-known because of it.

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