Medication Nonadherence Screening Tool—provides insight into factors that may contribute to nonadherence.
Have patient or caregiver gather all current medications (prescribed, OTC, herbal; remind about eye drops, liquids, inhalers, creams & ointments). This assessment needs to be done with the patient if the patient self administers or partially administers medications. This assessment should be done with the caregiver who administers the medications if the patient does not self-administer.
STEP 1 Determine what the patient knows
Determine what the patient (supplement caregiver when appropriate) knows about their medication regimen.
Sit down with the patient with all medications within reach. The clinician opens the first bottle and pours out two or three pills into the lid of the bottle and shows this to the patient and asks “What is the name of this medication?”
Do not allow the patient to see the label on the bottle yet. Then ask “What do you take this medicine for?”
Follow these questions with “How much and how often do you take this medicine?”
Ask the patient to identify the color of the tablet or capsule being shown. Record reported information on Medication Nonadherence Risk Assessment Form.
STEP 2 Label Reading
After returning the pills to the bottle, hand the bottle of medicine to the patient. If the patient was not able to tell you the name of the medicine just by seeing the pill; ask the patient to read the label and tell you the name of the medicine. Then ask the patient to tell you how many refills they have left. This step will provide some insight into the patient’s ability to read labels and identify specific components of the label.
STEP 3 Perceived Efficacy & Safety
While the patient is still holding the prescription bottle, say the name of the drug again and mention the reason for use that was
self-reported. If the reason stated does not make sense, mention to the patient the typical reasons that this type of medicine is prescribed.
Example 1: “Now Mrs. Smith you have in your hand your Accupril. You said that your doctor gave this to you for your blood pressure and your heart. In your opinion how well do you believe this medicine is working for you?” Wait for the answer and then ask, “Have you had any side-effects or problems taking this medicine?” Record the patient’s answers on the assessment form.
Example 2: “Now Mr. Jones you have in your hand your Accupril. You said that your doctor gave this to you for your prostate. Accupril is usually used to lower blood pressure, help the heart, or protect the kidneys particularly in patients with diabetes.” Pause for the patient’s reply. Usually this type of information will jog their memory or they may say something like “Well I do have high blood pressure, maybe I got my information mixed up.”
You can also help relieve anxiety by stating that you will double-check with the patient’s doctor about their medicines and what the doctor is using them for, and you will share this information with the patient later. Finally, for each medication you should ask if the patient thinks that this medication is necessary and record their answer on the assessment form.
STEP 4 Demonstrations
• Have the patient demonstrate the ability to open various packaging that their medications are currently in. Example: pill bottle, eye drop bottle, unit dose packaging, pillboxes (some have very tight seals and small grasps).
• Have the patient demonstrate the ability to self-medicate appropriately. For example say ”I want you to pretend it is morning and it is time to take your medicine. Show me what and how much medicine you would take.” Have the patient do everything they would do to prepare to take their medicine without actually taking it. If there are special instructions, such as take on an empty stomach or take with food, or multiple inhalers, or eye drops, ask the patient to tell you exactly how they would take everything. For pill box patients, have them demonstrate the proper use of the pill-box.
Patient Specific Demonstrations
• If the patient uses an inhaler, nebulizer, eyedrop or other non-oral medication, have the patient demonstrate technique or at a minimum describe technique.