What are some of the key barriers patients face regarding medication adherence in chronic disease management, and what are the interventions to address them?
Medication adherence is a well-known challenge in chronic disease management, and it should be seen as more than just taking pills as prescribed by clinicians. It is a behaviour influenced by a wide range of factors. Patients may struggle with adherence because they do not fully understand their condition, feel uncertain about the benefits or side effects of treatment, or face practical barriers such as cost, access or forgetfulness.
Effective interventions need to go beyond reminders or education alone. They should involve actively listening to patients, understanding their concerns, and supporting them in making treatment decisions that align with their values and daily lives. Strategies such as shared decision-making, motivational interviewing, and improved communication between healthcare professionals and patients are key strategies to improve adherence.
Could you explain how Shared Decision-Making (SDM) contributes to improving medication adherence? What are some of the practical challenges in implementing SDM in primary care?
Shared Decision-Making (SDM) helps improve medication adherence by involving patients in their own treatment decisions. When patients understand their options and feel that their preferences and values are taken into account, they might be more likely to follow the treatment plan recommended by clinicians. This is particularly important in chronic conditions, where medications are often taken long-term and, in many cases, without noticeable symptoms.
Like many other interventions, implementing SDM in primary care presents challenges. Common barriers reported in our research and the literature include limited time during consultations, a lack of training for professionals, and traditional views of the clinician as the sole decision-maker. To integrate SDM into routine practice, it is essential to engage primary care organisations, provide appropriate training for professionals and incorporate decision aids and tools into electronic healthcare systems.
Interprofessional collaboration is central to your research on adherence in chronic disease management. How do GPs, nurses, and pharmacists work together in this model, and what impact does this have on patient's adherence outcomes?
In our research, the IMA-cRCT, we evaluated a SDM intervention in which GPs, nurses, and pharmacists collaborated to support patients when a new medication was prescribed for a chronic condition in primary care. Each professional played a distinct role: the GP discussed the condition and treatment options with the patient, and together they agreed on the treatment; the nurse provided follow-up and reinforced the information shared by the GP; and the pharmacist reinforced key information and checked the patient’s understanding when dispensing the medication.
This coordination and standardisation of care across primary care professionals aimed to ensure that patients received consistent information and felt supported throughout the process. However, our findings showed that the roles of GPs, nurses, and pharmacists in supporting medication adherence can be interchangeable in practice. In the Spanish context, where our study was conducted, nurses often are the main point of contact for patients, particularly in the management of chronic conditions. The role of pharmacists was less clearly defined. Although they acknowledged their potential influence on patient behaviour, communication with other professionals was very limited. In this context, enhancing their integration into primary care could strengthen collaborative care, as interprofessional collaboration is key to improving patient support and adherence outcomes.
Given your research findings, what policy or practice changes would you advocate for to improve medication adherence in chronic disease management?
I believe we need to continue shifting away from targeting only patients to improve non-adherence and start recognising it as a broader health system challenge. This involves investing in training healthcare professionals, not only on adherence, but also on communication and approaches like SDM, starting from university education through to ongoing professional development. It also means embedding decision-support tools into healthcare systems, launching public campaigns to encourage patients to ask questions and take an active role in their care, redesigning workflows to facilitate interprofessional collaboration, and ultimately integrating adherence support into routine practice.
Policies should also aim to reduce barriers for patients. For instance, by addressing co-payment systems, ensuring equal access to care, and tailoring interventions to meet the needs of individuals with complex social and economic circumstances.
What are the next steps in your research, and how do you envision the future of patient-centred interventions in chronic disease care?
Following our research, we are currently engaging with regional healthcare decision-makers to design a strategy for scaling up this SDM intervention across a wider region. Our aim is to expand its implementation and also to evaluate both the scale-up and implementation strategies, as well as the impact of the intervention in real-world conditions at a broader scale.
Looking ahead, we believe that patient-centred interventions play a key role in improving chronic disease management. We believe that by integrating these approaches into routine practice, we can move towards a healthcare system that is more collaborative, ethical, and effective.
If you are interested in CARE’s work in the field of medication adherence, get in touch: care@kcl.ac.uk