As Prescribed – Improving Adherence to Medications

When Jenny Shen, MD, first started her clinical training, she was surprised by the poor outcomes many dialysis patients face.

She also realized that many of those poor outcomes could be attributed to inadequate adherence to medications.

"Dialysis patients take an average of more than 15 pills a day and only about half of patients take these medications as prescribed," she said. "That could potentially cause harm, either by not taking medications, or by taking them in such a way that could be detrimental to a patient’s health."

Dr. Shen, 35, is an Assistant Professor of Medicine in the Department of Medicine, Division of Nephrology and Hypertension at Harbor-UCLA Medical Center. In a new research study, supported by the National Kidney Foundation’s Satellite Dialysis Clinical Investigator Grant, she will explore the patterns of adherence to medications used to treat cardiovascular conditions in ESRD patients, and how adherence affects health outcomes.

"For example, some people are very strict about taking their medications in the beginning but become less adherent over time, while others are the opposite, developing a consistent regimen over time," she said. "It’s important to identify the factors that might be related to different patterns so we can build tools to improve adherence to medications."

The first phase of the study will identify patterns of adherence and account for variables such as age, gender, race and ethnicity. Patients will then be monitored to identify how their particular adherence pattern is associated with adverse health events, such as heart attacks and strokes.

Results from the study will be used to create tools that can be customized to a patient’s needs. These interventions would ideally help patients develop an adherence pattern that will set them on a path toward optimal outcomes.

"The underlying principle is that one size does not fit all," Dr. Shen said. "It’s impossible to develop a single intervention to help all patients since every patient has different reasons for not taking their medications."

The ultimate goal of this research would be to decrease the burden of heart disease in high-risk groups by improving adherence to effective medications. However, the research could also be applicable to other medication regimens and disease states.

The first set of results should be completed by the end of 2015, but researchers will continue to refine and redefine their work moving forward.

"This sets the foundation for developing programs to help patients improve adherence to medications," she said. "The next step will be to talk directly to patients about their experiences taking medication to figure out, in a more qualitative way, how to help them."