Improving Medication Adherence


Keep a watch…on the faults of the patients, which often make them lie about the taking of things prescribed. For through not taking disagreeable drinks, purgative or other, they sometimes die.

Hippocrates, Decorum


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Doctors ask: Why do patients not take their medicine as prescribed? Maybe patients are asking: What are healthcare providers doing to support medication adherence? Years back, I was a patient who needed to take just a single tablet of bromocriptine everyday. I didn’t remember to take it every night! I was in my final year of residency when I diagnosed myself as having a prolactinoma and needed to take medication. But even before that, when this condition began manifesting as menstrual irregularities, my gynecologist prescribed oral contraceptive pills. I also often forgot to take them! Until I finally decided I didn’t want to continue taking these pills. My menses stopped completely for almost a year – and that’s how I realized  I had a pituitary problem.  Yes, doctors who become patients are not adhering better to medication.

A few months back, I gave a presentation on tools to improve adherence to diabetes treatment. I focused on apps. I became even more aware that more work is needed in this area.


Tools For Improving Adherence to Treatment in Diabetes from Iris Thiele Isip Tan


The World Health Organization defines adherence as –

the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider.


Is it mere forgetfulness? Check out the full WHO document here. According to the WHO, adherence is a multidimensional phenomenon with five aspects. It is important to note that patient-related factors is only one aspect. In the Philippines, socioeconomic factors are definitely important. I trained in a government hospital. I witnessed first-hand how patients were not taking medications, not because they didn’t understand the doctor’s instructions but because they weren’t even able to afford buying them. It still happens in my private practice.



Join me again at #HealthXPh tweet chat on Saturday, 1 November 2014 9 pm Manila time as we discuss the following:

T1 What aspects are not addressed by current strategies to improve medication adherence?

T2 What are strategies to improve medication adherence that do not require new technology?

T3 As a healthcare provider or patient, do you recommend or use medication reminder apps?

Health Records: It’s Personal

Do you go and see many doctors for different problems? Do you have a chronic condition needing follow-up visits and repeat testing? If so, you probably need a personal health record (PHR).

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According to,

The PHR is a tool that you can use to collect, track and share past and current information about your health or the health of someone in your care.

Although personal health records can be paper-based, more recent usage of the term implies an electronic tool. Another definition at healthIT gov states –

A personal health record (PHR) is an electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment. PHRs:

  • Are managed by patients
  • Can include information from a variety of sources, including health care providers and patients themselves
  • Can help patients securely and confidentially store and monitor health information, such as diet plans or data from home monitoring systems, as well as patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, and much more
  • Are separate from, and do not replace, the legal record of any health care provider
  • Are distinct from portals that simply allow patients to view provider information or communicate with providers

I live in an archipelago of 7,107 disaster-prone islands called the Philippines. When patients come to see me in the capital of Manila, it is often difficult to retrieve medical records from the geographically isolated areas from whence they came. It is also next to impossible to retrieve medical records that have been lost through fire, flood or earthquake. I have been privileged to meet patients with personal health records, often paper-based – think plastic bags or envelopes containing loose sheets of illegible prescriptions, clinical summaries faded from flood water stains or half burnt around the edges to folders containing dog-eared carbon copies of lab results. These are the patients who come to my clinic, ready to tell their story and take active part in their treatment. They watch hungrily as I peruse their personal health records. I barely hear them sigh when I close the folder (or gather up the loose pages into the envelope or plastic bag) and gaze up at them. Their eyes meet mine in an unspoken question, “Well, what do you think Doctor?”

And so I agree with Tang et al –

“Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care.”

Tang PC et al. Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption. JAMIA 2006 Mar-Apr; 13(2): 121–126.

Let’s talk about personal health records at #HealthXPh tweet chat this October 4, 9 pm Manila time (9 am EST).

T1 What are the barriers for individuals to keep personal health records?

T2 Which do you prefer and why – online, electronic or paper based personal health records?

T3 Which is better – provider-maintained or patient-owned personal health records?

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