Philadelphia: Lippincott Williams & Wilkins, 2006
184 pages, $29.95 (softcover)
Author: Shawn Christopher Shea
In the United States and other Western countries, the most common health care intervention is not delivered by a physician or performed while in a hospital but is carried out by patients themselves, at home, through the simple, yet critical act of taking a medication to manage a chronic illness. Many previously fatal illnesses are now chronic ones that can be managed with a simple catch—positive outcome depends on the person taking the medication over months, years, and sometimes even decades. How frequently does this type of adherence occur?
Sadly, not often enough. In the United States, 30% to 70% of patients who fill an initial prescription for hypertension, hypercholesterolemia, cancer, or depression (among others) will not refill their prescription in the following 12 months.1 The result: treatment that should succeed often fails.
Improving Medication Adherence: How to Talk with Patients About Their Medications, by Shawn Christopher Shea, is a slim and excellent primer on the verbal strategies and interviewing tips that clinicians can use to improve medication adherence. Shea, a practicing psychiatrist and assistant professor of psychiatry at Dartmouth Medical School in New Hampshire, correctly and critically observes that medication adherence is an extension of the clinical alliance. To this end, the book provides both general strategies and specific tips (42 in all, which are conveniently listed in the appendix) on how to develop a clinical alliance that promotes medication adherence. Examples include asking the patient about the dreams the illness has destroyed and how the use of medication might help restore them (eg, how asthma medication might help a child play sports again); assessing the patient's past response to medication as a basis for anticipating and managing personal bias for or against future medication use; and not forcing the initial decision to try medication on the patient, but clarifying which symptoms of the illness are worth treating so the patient ultimately makes the choice to try medication.
The list, of course, goes on, which is why you should read this book. One of the things I most liked is how the book models specific language, questions, and thinking that can be used to improve medication adherence. As a psychiatric resident, I often found it frustrating to hear senior clini- cians conduct patient interviews that seemed impossible to replicate. Here, however, the extensive use of clinical vignettes and the tips provided succeed in making this a practical "how to" guide for prescribers and nonprescribers in medical and mental health settings.
Future editions of the book might do well to include graphs with population-based data showing how patient tendency to continue using a medication is dismally short-lived across medication classes, especially in the first 30 days after the initial outpatient prescription is filled. Otherwise, this fine resource may end up preaching to the converted rather than reaching the broader audience it deserves.
While our professional journals spill over with research findings, this wonderfully practical book takes us back to the core of our profession—helping us make contact with those we treat so that the medications we prescribe, and the good outcomes they can enable, are used to their utmost advantages.