Dana, a colleague with diabetes, is diligent about eating right and exercising, so you’d expect her to be on top of her medications, too. But she recently told me that, several times each week, she fails to take the before-dinner pill her doctor prescribed. It’s not that she thinks the drug is unnecessary or worries about side effects (though these are common reasons why people intentionally skip their meds). Instead, Dana said, she simply forgets.
She’s hardly alone—an estimated 50% of patients do not take their medication as prescribed. The number-one reason, according to a recent survey published in Patient Preference and Adherence, is forgetfulness. But when needed meds are missed, a person’s health can suffer. In fact, more than 10% of hospital admissions among older adults may be attributed to medication nonadherence.
Traditionally, doctors have tried to educate and motivate patients about the importance of taking their medications, but with little effect. Now, though, a new way of dealing with the problem—called a personal systems approach—is showing great promise. “The idea is to teach people how to use their own routines and environment to ensure that their medications are there at the times they need to take them. With this approach, patients don’t need to worry about forgetting because the medications are automatically built into their daily lives,” said Cynthia Russell, PhD, RN, a professor at the University of Missouri-Kansas City School of Nursing who has studied medication adherence.
For a personalized approach that makes it easy to remember your meds…
Think through your routines. What is a typical weekday like for you? How about a weekend day? In a log, write down as much as you can about these routines—what time you get up…where and when you eat each meal…the door through which you leave the house…what you do before dinner…how you prepare for bed. Also consider what happens when a routine goes awry. You may realize that you often forget to take your pill with your morning orange juice because when you’re running late, you rush off to work without the juice—or the pill. Analyze weekly and monthly routines, too. For instance, if you spend one weekend per month out of state, take notes on that as well.
Compare your routines to your medication schedule and identify easy matches. Look for things that you do consistently. If you need to take a pill on an empty stomach, your log should help you spot a convenient opportunity—perhaps right after brushing your teeth in the master bathroom each morning. If a drug must be taken with food, stick with the meal that you eat most consistently (for example, if you often skip breakfast, take your meds with lunch). Clearly, the more medications you take, the trickier this can be, so ask your doctor which drugs can be taken together for simplicity’s sake and which must be spaced apart. “Then look for solutions that don’t rely on motivation or memory. Once the change is started, you shouldn’t have to try to remember,” Dr. Russell said.
The right solution is different for everyone, but Dr. Russell described several methods that worked for her patients. One woman who often left the house in a hurry started keeping her morning pills in her car. Another patient was always at her desk at her 8 pm medication time, so she stashed her pills next to her computer. A woman who never forgot to give her dog his twice-daily meds began storing her own drugs next to the dog’s—after marking the bottles so they didn’t get mixed up!
Recruit a helper if that person is involved in your medication routine. If another household member needs to take a pill at the same time of day as you, ask him or her to join you—so you can support each other’s personal medication routines. High-tech helpers: Program the calendar on your computer to issue medication reminders…set the alarm on your cell phone to ring at the appropriate time each day…or try a smartphone app (I’ve heard good feedback on the RxmindMe Prescription/Medicine Reminder and Pill Tracker app).
Keep track of your progress. In Dr. Russell’s research, patients use a special pill bottle with an electronic cap that records the date and time every time it is opened. She explained, “We print out the data and go over it monthly to determine whether a patient’s changes have helped her reach her goals.” (Your doctor can obtain this product, the Medication Event Monitoring System from Aardex, to use with you for about $120, Dr. Russell said.) Low-tech option: Keep a notebook next to your medicine bottle and log the date and time you take your pills. After two weeks, check your records to see how you did. If you missed any doses, reevaluate your routine.
Success story: When I suggested that my colleague Dana try this personal systems approach, she discovered the root of her problem. She kept her diabetes pills in the medicine chest in her upstairs bathroom—but she didn’t even go upstairs when she got home from work, instead going straight to the kitchen to prepare dinner. Moving her pills from the bathroom to the kitchen cabinet where she kept her dinner plates made all the difference. For backup, she asked her husband to always inquire about her meds as soon as they sat down to eat. As a result, her blood glucose levels improved significantly. Dana even posted her latest lab report on her refrigerator to remind her of how well she’s doing…and to inspire her to keep at it.