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Keywords: Medication regimen, adherence, patient-provider communication, social media.
Citation: Kastner K. Medication adherence: more than reminders. J Participat Med. 2011 Oct 3; 3:e46.
Published: October 3, 2011.
Competing Interests: The author is the CEO of the Health Television System, Inc., which produces and distributes patient education videos.

I regularly receive notices of medication adherence “apps,” dispensers, and strategies, each dedicated to making sure we remember to take our meds. However, focusing on reminders alone ignores the many other factors that contribute to nonadherence, improper use, and potentially harmful results. The National Coordinating Council for Medication Error Reporting and Prevention reported 1.3 million injuries from medication errors annually. This is echoed in a recent study by the Institute for Safe Medication Practices Canada, Canadian Patient Safety Institute, and Victorian Order of Nurses, in which almost 50% of the 600 surveyed had medication discrepancies, amounting to 2.3 discrepancies per client. Top contributing factors were multiple chronic diseases, a complex medication regimen, and the ability to understand one’s medication regimen.

This report validates what I have learned from the patient education TV networks that I produce: that reminders alone will not likely solve the problem of medication nonadherence. I have been collecting stories about communication between patients and providers that result in intensifying side effects, nonadherence and/or harm. For example, instructions for one of the medications taken by an elder patient were: “Take one when you wake up.” The patient tended to snooze during the day and, every time he woke up, took another pill!

So, one of the key questions in participatory medicine is how to make our health and medication regimen fit into our life, so that we can consistently follow it. This is often more easily said than done, however. Consider the woman who changed her diet, adding lots of grains, greens, cheeses, yogurt, and tofu so that she would be healthier. Unfortunately, one of her prescriptions specified that she was to eat no dairy and minimize leafy greens. So, she experienced a severe reaction to the medication to the point that she “thought [she] was going insane.” Since many elderly patients take ten or more medications, getting all of the instructions and adhering to all of the precautions is a very difficult task.

Most pharmacists will provide a printout about the prescribed medication, there are patient inserts in packages, and, of course, there is a plethora of information on the internet. But, if medication adherence is so well covered, why are medication nonadherence and medication errors still such a prevalent issue?

One tool that I have decided to use is social media, in this case YouTube, to promote a change in thinking about medication adherence and awareness of what patients should think about to more effectively participate in their own care.

I was told by a professor of pharmacology that his students proved the need for more thoughtful medication compliance education: “Every year I ask my students for their interpretation of ‘take 3 times a day with meals.’ Their answers prove the need for clarification.” If interpretation is an issue for pharmacy students, what about the rest of us?

Copyright: © 2011 Kathy Kastner. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.