Overview
Research has shown that patients often have difficulty knowing how and when to take their medicines, especially if their regimens are complex. It is a safety issue if patients take their medicines incorrectly or not at all. Helping patients understand and remember their medicines increases the chances they will take the medicines they need to get and stay healthy and can reduce errors.
Actions
Prevent errors.
- Use evidence-based instructions, which are available in English, Chinese, Korean, Russian, Spanish, and Vietnamese. Add these instructions to your electronic health record (EHR) for eprescribing.
- These instructions are precise, minimizing confusion. For example, "Take 1 pill in the morning and 1 pill at bedtime" is unambiguous, whereas "Take twice daily" could lead to errors if patients do not know to spread out the doses.
- These instructions simplify complex medicine regimens by using standard time periods (i.e., morning, noon, evening, and bedtime). They make it easier for patients to take their medicines correctly by clustering medicines and reducing the number of times a day patients take medicine.
- Be explicit if any medicines should not be taken together, or if there is anything they should not eat or drink near the time they take the medicine.
- Include in your prescription a plain language description of what the medicine is for (e.g., "for high blood pressure").
- Discuss and resolve patients' concerns. Ask patients if anything makes it difficult or prevents them from taking their medicines.
- Pay attention to reports of side effects; otherwise, patients may stop taking medicines without telling you.
- If the difficulty is financial, use Tool 19: Help Patients Pay Less for Medicine.
- If the difficulty is physical (e.g., cannot open containers) or cognitive (e.g., gets medicines confused), you can work with pharmacies that will presort medicines so patients have an easy-open packet of everything they need to take for each time of day. Also, see the strategies below to help patients remember to take their medicines.
- If the difficulty is logistical, use the strategies in the below section, Make it easy to get medicines.
- Consider prescribing options.
- Blister packs can make it easier to take medicines that require tapering off.
- Combination medicines or medicines requiring fewer doses (e.g., extended release) can mean fewer pills to take. However, these medicines can be more expensive. Tool 19: Help Patients Pay Less for Medicine may be helpful.
- Suggest patients always check medicine labels. Refills can come in different colors, shapes, and sizes. Tell patients that if the name of the medicine and the dose are the same as what they are used to taking, their medicine will work the same way and should be taken as directed. Encourage patients to talk with their pharmacist if they have questions or concerns about what they received.
Provide patients with a list of medicines.
- Include all prescription and over-the-counter medicines, as well as supplements.
- Figure out how your EHR can produce a medicine list that clearly shows when and how to take medicines. The list should be organized so it is easy to see when to take medicines over the course of a day.
Alternatively, provide patients with one of these lists that clearly show what medicine to take at each time of day and how much to take:
- You can fill in the list on paper or electronically with patients during Brown Bag Medicine Reviews. Include blank sheets so patients can add to it.
Make it easy to get medicines.
- Simplify refills.
- Reduce how frequently patients need refills. Many prescriptions can be reasonably prescribed with a 90-day supply.
- Prescribe refills for a year whenever it is reasonable. At a minimum, ensure that there are enough refills to last until they next need to check in with a clinician.
- Synchronize the dates medicines need to be refilled whenever possible, so patients can make fewer trips to the pharmacy.
- Find out if patients would like medicines mailed to them instead of having to pick them up at the pharmacy.
Help patients remember to take their medicines.
- Ask patients if they would like help remembering to take their medicines. You might say, "Everyone forgets to take their medicine from time to time. Would you like to talk about ways to make it easier to remember to take your medicine?"
- Suggest they create a routine to take medicines with activities they do at the same time each day (e.g., meals, brushing teeth).
- Provide pill organizers, and teach patients and caregivers how to fill them using their medicine list as a guide.
- Enlist help from family members. Family members can play an important role in reminding patients to take medicines, filling pill boxes, or setting up electronic reminders.
- Review options for electronic medicine reminders. Offer help in choosing and setting up technologies that can remind patients to take medicines. These include:
- Setting alarms on phones, watches, timers, tablets, voice assistants, or talking clocks.
- Medicine reminder apps. Offer assistance in selecting an app and downloading or entering their medicine information into it. If your EHR has an easy-to-use medicine reminder app, using it will reduce the chance of errors being introduced when entering information.
- Smart pill bottles and pill boxes that sound an alarm, flash lights, or send a message when it is time to take pills. These are available online and at some pharmacies.
- Publicize ways you can help. Hang the Help with Medicine Poster in your exam room or waiting rooms.
- Document reminder strategies, so everyone can reinforce them or suggest new strategies if needed. If you have an EHR, coordinate across the practice so everyone documents reminder strategies in the same location鈥攐ne that you can query.
Track Progress
One month after implementing this tool, ask for volunteers at a staff meeting to use Role Play 2 in the appendix. See how well they do and whether others can identify possible improvements.
Before implementing this tool, randomly select at least 20 medical records of patients who regularly take medicines and were seen in the last week. Identify the percentage of patients who take medicine and had a medicine reminder strategy documented in their medical record. Check again in 2, 6, and 12 months.
Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions.
Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.
