Annual Monitoring for Patients on Persistent Medications

Your patients who take medications for chronic conditions may be at increased risk for adverse drug effects or problems relating to nonadherence. While yearly testing for patients on medications such as angiotensin-converting enzyme inhibitors (ACE inhibitors), statins, and anticonvulsants to monitor blood levels and organ functioning is essential, blood tests can’t replace good communication with your patients. Encourage your patients to ask questions during office visits.

Close to 120 million Americans live with one or more chronic diseases. Over one-half of seniors between 70 and 79 have two or more chronic conditions.

Help Improve Drug Adherence
Patients who take medications for chronic conditions may be at increased risk for poor outcomes because of nonadherence to drug regimens. The reasons for nonadherence range from uncomfortable side effects to forgetfulness to misunderstanding the instructions.

You can help improve patient adherence in the following ways:

• Schedule follow-up office visits. Make reminder phone calls or send reminder e-mails to reinforce how important it is for your patients to take the prescribed dose. Offer suggestions such as pill calendar boxes that help patients remember to take their medication.

• Ask your patients what problems they are experiencing. For example, what are the barriers preventing them from complying with the drug regimen (eg, does taking the dose affect their ability to work because of decreased concentration, or does the taste or the smell of the medication prevent them from taking it)?

• At each office visit, verify that there is an indication for each drug the patient is taking, that each drug is effective, that there is no unnecessary duplication, and that each medication is the least expensive option available of comparable benefit.

Did You Know?
• Approximately 50% of patients leave a visit with their physician without understanding what the doctor has told them.

• Asking patients to repeat back the important information you have discussed is one way to clear up misunderstandings.

Encourage Self-Care
Health care for senior patients is more effective when it is carried out in collaboration with patients and their caregivers. You can foster this kind of collaboration by:

• Letting patients and caregivers know how they can access the information and services they need; for example, giving them the phone number and URL for the American Diabetes Association, as well as the address of the local chapter.

• Developing individual goals with your patients, such as increasing physical activity, which can be monitored and evaluated with personal action plans.

Did You Know?
• Patient compliance with drug regimens for chronic conditions having no symptoms is only about 50%.

• One study showed that phone calls once a week from a nurse manager and once a month from a physician improved blood sugar control and weight loss in diabetic patients.

Provided as an educational resource by Merck