Medication Adherence:

Discussion Questions for the Educational Module

(The full module is available at http://www.cdc.gov/primarycare/materials/medication/index.html)

(May be used before or during the presentation)

1. Discuss the ways that team-based care can improve patient medication adherence.
Team-based care involves effective collaboration among healthcare providers of diverse disciplines.
The team works towards a common goal of improving outcomes by providing quality health care
using a patient-centered approach.14
Team-based care can improve the effectiveness of cause-specific medication adherence
interventions by allowing team members to use their individual skills to maximize patient care. Most
of the current evidence on team-based care and medication adherence focuses on pharmacists
roles.5,6 Systematic reviews have shown improved patient adherence to blood pressure and lipid
medications when pharmacists provided one or more of the following team-based care
strategies:4,68
Recommending medication to the clinician
Educating the patient about disease, lifestyle, and medication doses, frequency, and timing
Completing a drug profile or medication history
Assessing the patients medication compliance
Ordering lab tests if needed
Research has shown that a patients chronic condition can improve when physicians and
pharmacists work together using a medication therapy management (MTM) approach treatment
plan.5,6,8 Specifically, a six-month trial of physicianpharmacist collaborations demonstrated better
control of blood pressure in the intervention group than the usual care group.9,10 MTM is a service or
group of services by pharmacists that optimizes therapeutic outcomes for individual patients by
identifying, preventing, and resolving medication-related problems.11 Pharmacist-provided MTM
services are recognized through pharmacist-only current procedural terminology (CPT) codes for
billing, and MTM is used as an abbreviation with the CPT codes. CPT codes provide a standard
nomenclature of communication between healthcare providers and payers.
2. Discuss how changes at the individual and practice levels can improve medication adherence in a
population.
At the individual level, medication adherence is often affected by condition-related, therapy-related,
and provider-related factors, as well as individual physical and psychological issues. Healthcare
providers can work together to improve medication adherence in their patients by using the
SIMPLE strategy:
S Simplify the regimen (e.g., adjust the timing, dosage, or frequency of medication)
I Impart knowledge (e.g., distribute written information about the medication or health
condition)
M Modify patient beliefs and behaviors (e.g., assess benefits and barriers to adherence)
1

P Provide communication and trust (e.g., actively listen to the patient)

L Leave the bias (e.g., tailor the education to the patients level of understanding)
E Evaluate adherence (e.g., count the patients pills)
The SIMPLE approach requires healthcare providers to focus on communication skills, cultural
sensitivity, and patient-centered interviewing.12,13
At the practice level, medication adherence can be improved through patient-centered care
practices, which improve access to care and allow patients to be more proactive and engaged in
their care; examples include patient portals and automatic reminders. The following system
reorganization techniques6 can be helpful in improving medication adherence:
Meaningful use of health information technology
Clinical decision support systems
Team-base care
Educational interventions (e.g., programmed learning for patients and providers)
Behavioral interventions (e.g., simplified dose regimens)
Rewards (e.g., free medications, reduced co-pays)
In conclusion, medication adherence can be improved at the individual level by using SIMPLE and at
the practice level by integrating patient-centered care practices with enhanced communication skills
between providers and patients.6;12
References
1.

Arend J, Tsang-Quinn J, Levine C, et al. The patient-centered medical home: history, components, and
review of the evidence. Mount Sinai Journal of Medicine 2012;79:43350.
2. Armstrong JH. Leadership and team-based care. Virtual Mentor 2013;15:5347.
3. Hill MN, Miller NH, DeGeest S. ASH position paper: adherence and persistence with taking medication to
control high blood pressure. Journal of Clinical Hypertension (Greenwich ) 2010;12:75764.
4. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and
teamwork in hypertension therapy. Journal of Clinical Hypertension (Greenwich ) 2012;14:5165.
5. Carter BL, Ardery G, Dawson JD, et al. Physician and pharmacist collaboration to improve blood pressure
control. Archives of Internal Medicine 2009;169:19962002.
6. Carter BL, Rogers M, Daly J, et al. The potency of team-based care interventions for hypertension: a metaanalysis. Archives of Internal Medicine 2009;169:174855.
7. Van Wijk BL, Klungel OH, Heerdink ER, de BA. Effectiveness of interventions by community pharmacists to
improve patient adherence to chronic medication: a systematic review. Annals of Pharmacotherapy
2005;39:31928.
8. Odum L, Whaley-Connell A. The role of team-based care involving pharmacists to improve cardiovascular
and renal outcomes. Cardiorenal Medicine 2012;2:24350.
9. Heisler M, Hofer TP, Schmittdiel JA, et al. Improving blood pressure control through a clinical pharmacist
outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence
and intensification of medications cluster randomized, controlled pragmatic trial. Circulation
2012;125:286372.
10. Hunt JS, Siemienczuk J, Pape G, et al. A randomized controlled trial of team-based care: impact of
physician-pharmacist collaboration on uncontrolled hypertension. Journal of General Internal Medicine
2008;23:196672.

11. CDC. A Program Guide for Public Health: Partnering with Pharmacists in the Prevention and Control of
Chronic Diseases. 2012. Available at
www.cdc.gov/dhdsp/programs/nhdsp_program/docs/Pharmacist_Guide.pdf.
12. American College of Preventive Medicine. Medication Adherence Time Tool: Improving Health Outcomes.
A Time Tool for the Healthcare Providers. A Resource from the American College of Preventive Medicine.
2011. Available at
www.acpm.org/?page=MedAdherTT_ClinRef&hhSearchTerms=Medication+and+Adherence+and+Clinical+
and+Reference.
13. Atreja A, Bellam N, Levy SR. Strategies to enhance patient adherence: making it simple. Medscape General
Medicine 2005;7:4.