Strategies to Improve Medication Adherence in Youths
Within the 21st century, pharmacological interventions have become more standard features of psychiatric treatment for adolescent patients. However, as successful treatment may rely on regular doses of medicine, a major obstacle for many adolescents and clinicians has been medication adherence. A lack of adherence can lead to less-than-successful outcomes in the management of chronic psychiatric disorders. Michigan State University College of Human Medicine Department of Pediatrics Professor Donald E. Greydanus, MD and University of Medicine and Dentistry of New Jersey Department of Psychiatry Clinical Associate Professor Gabriel Kaplan discuss approaches to improve medication adherence in their article “Strategies to Improve Medication Adherence in Youths.”
For clinicians, improving medication adherence has proven to be a difficult effort, especially as there does not exist an evidence-based strategy that ensures improvement in cases across all disorders. However, Greydanus and Kaplan state that a clue that medicine is not being adhered to is when progress is not being seen.2 Therefore, counseling the adolescent patient on the importance of their medicine and building a therapeutic relationship during the process will usually result in progress, compared with switching medicines, increasing dosages, or adding a second medicine.2 In fact, many clinicians and researchers agree that to improve medication adherence, a clinician should discuss with the patient the importance of taking their medicine, set up reward systems for adherence, educate both the adolescent patient and their parents/caregivers on the need for adherence, and use supplementary health care workers for educational purposes, such as nurses, social workers, and primary care physicians.
Greydanus and Kaplan stress the importance of building patient rapport during the treatment process, as it increases medication adherence.2 Limited communication with an adolescent patient leads to non-adherence; therefore, building up a strong rapport from the initial evaluation is crucial. Minimal time spent communicating with the patient leads to a patient’s lack of trust and respect for the clinician, which results in lack of medication adherence and problems with treatment recommendations.2 Also, if the initial clinician is unavailable to direct long-term support for the patient, the new clinicians should spend time building up a rapport with the patient just as the initial clinician had, or treatment success may cease.2
There are several parts of successful treatment, and all must be met to ensure a successful outcome for adolescent patients. Greydanus and Kaplan state that there are six A’s of basic outpatient care: availability, accessibility, approachability, acceptability, appropriateness, and affordability. If the clinician is not readily available or accessible to the adolescent patient suffering from a chronic disorder, competent care will not be met.2 The same goes for approachability—if the clinician is not, or does not seem, approachable, they will not be successful in treating the adolescent’s disorder long-term. It is difficult for an adolescent to build a therapeutic relationship with a clinician that they find difficult to approach.2 The patient also needs to feel accepted, liked, and need to be welcomed warmly by their clinician. Even if the attitude of the patient or their family is cold, the clinician and their office personnel need to emanate an appropriate warm and welcoming attitude at all times.2 Also, with cost always being a common barrier to treatment, affordability should always be kept in min.2
The clinician should build the trust of both the adolescent and their parents/caregivers when prescribing medicine for long-term use. While the use of psychotropic medicines has become more and more standard among adolescent patients, they may be weary of their use, as well as their parents/caregivers. Therefore, the clinician, as trust builds, should continue to clearly explain the need for such medicines and over time, the family’s distrust will vanish. However, failing to include patients and their families in treatment decisions will also often result in medication non-adherence.2
More recently, there have been adherence-enhancing techniques that many clinicians have integrated into their systems of care. Technology has allowed clinicians to provide question-answering via email—a technique welcomed by many adolescents.2 Also, many practices send out text reminders of medication times, which have shown to be helpful by many as adolescents can be forgetful.2
While medication adherence still proves to be a difficult problem in treating adolescents, there are ways to improve adherence and therefore improve treatment outcomes. According to Greydanus and Kaplan, building an open and therapeutic relationship with both the patient and family, educating them about the need for long-term medicine, and staying available and accessible to the patient and family’s needs will improve adherence. Also, as new technology offers new ways of incorporating extra communication and medication reminders, adherence is sure to improve even more.
 Greydanus DE, Patel DR, Feucht C. Pediatric Psychopharmacology in the 21st Century. New York: Saunders; 2011.
 Greydanus, D.E. and Kaplan, G. (2012, March 26). Strategies to Improve Medication Adherence in Youths. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/child-adolescent-psych/content/article/10168/2050780
 Haynes RB, Yao X, Degani A, et al. Interventions to enhance medication adherence. Cochrane Database Syst Rev. 2005;(4):CD000011.
 Eisenmann CM. Revising a medication education program on an inpatient child and adolescent psychiatric unit. J Psychosoc Nurs Ment Health Serv. 2012;50:42-47.
 Hofmann AD. Providing care to adolescents. In: Hofmann AD, Greydanus DE, eds. Adolescent Medicine. 3rd ed. Stamford, CT: Appleton & Lange; 1997:39.
 McLeod JD, Pescosolido BA, Takeuchi DT, White TF. Public attitudes toward the use of psychiatric medications for children. J Health Soc Behav. 2004;45:53-67.
 Croghan TW, Tomlin M, Pescosolido BA, et al. American attitudes toward and willingness to use psychiatric medications. J Nerv Ment Disord. 2003;191:166-174.