The percentage of prescribed medications that are actually taken by patients is estimated to be as low as 60%-and among patients with chronic conditions, it may be even less. Patients with mental disorders may have even lower rates of adherence than those with physical conditions. Suzanne Hardeman, an NP and licensed professional counselor, and Meera Narasimhan, a physician, have culled from the available literature a list of strategies that have been shown to improve adherence in patients with mood and psychotic disorders.

At the top of their list-and what they refer to as the "sweetest of all" approaches to fostering medication adherence in this population-is a trusting relationship between provider and patient. In the research they examined, adherence was about 80% when patients could discuss treatment with physicians. Providers, write Hardeman and Narasimhan, should practice positive, respectful communication with patients, considering issues such as literacy, language barriers, and the patient's cognitive state. The authors found that it's also important to set treatment goals, specifically focusing on remission rather than on preventing relapse. "Linking the goal of remission to personal goals," they write, "strengthens willingness to embrace the treatment plan."

Another strategy is simplifying treatment whenever possible, through the use of pillboxes, long-acting medications, handheld alarm devices, or behavioral prompts. Educating and working with pharmacists and families can also increase adherence. In an interview with AJN, Hardeman said that one of the most important ways nurses can address the issue is by anticipating it. "We shouldn't be surprised when people don't take their medications. Thirty percent to 50% of medications prescribed won't be taken at all-patients don't even get the prescriptions filled," she said. "And we blame adverse effects and cost, but neither has been shown to be the reason patients don't take their medications."

Hardeman said that nurses should talk about medication at each assessment, avoid chiding patients, and word questions in a way that will elicit an honest response. She gave the following example: "Instead of asking if they take their medication, I say, 'Most people tell me they don't always take their medication. How many days did you take yours last week?'" That kind of question leads to a discussion of why the patient didn't take medication, said Hardeman, and helps set goals and provide strategies for adherence.

Tammy Worth