The Role of the Therapeutic Relationship
Since adherence relies upon the patient’s knowledge, skills, and motivation, enhancing patient engagement is an integral part of addressing nonadherence.9 For patient engagement to take place, there must be “effective, caring, and mutually respectful patient-relationships” between patients and their healthcare providers. Patients prefer to be treated by empathetic clinicians who are good listeners and competent at informing, advising, and educating them.9 Clinicians should be alert to clues of potential nonadherence (eg, missed appointments, missed refills, or evasiveness) and ask patients about how they are coping with their treatment regimen, using a direct but nonconfrontational approach.10
Strategies to enhance physician-patient communication are listed in Table 2.
The Critical Importance of Monitoring
It is important to recognize that adherence may be overestimated both in research and in clinical practice.4 An eight-week study of 67 patients with relapsing-remitting MS found significant discrepancies between self-reported missed doses and those captured via electronic needle disposal monitoring. Nearly one-fifth of the sample exhibited poor adherence (ie, missing more than 20% of their prescribed medication).11 Monitoring can be done during in-person consultations or via telemedicine. (Telemedicine can be defined as ‘the exchange of medical information from one site to another via electronic communications to improve the health status of patients.”)12 A recent study found a brief telephone-based assessment of adherence expectation to be an “easy and efficient measure” for monitoring medication adherence among patients with MS by detecting and supporting individuals who may benefit from additional interventions to promote adherence.1
Addressing Injection-Related Concerns
Fear of injections has been shown to be a major contributor to nonadherence in patients with MS. The first step in addressing this is to allay concerns about the safety of injections by educating patients about proper medication preparation and injection technique.10 Cognitive reframing, relaxation techniques, and addressing adverse effects are important components in alleviating injection anxiety.10 It can help to reframe the role of injections as means to maintain future health rather than merely a present-day burden of the disease.