Patient self-reports can be a useful tool for providers to assess patient adherence. There are strategies that can help providers maximize the accuracy of patient self-reports to help them develop individualized adherence interventions for their patients.

LEANDRO MENA, MD: Viral load suppression can be a reliable indicator of medication adherence. But which other methods do you use in your clinical to supplement that and truly, you know, to be able to identify when adherence starts failing before viral load fails? 

CYNTHIA RIVERA, MD: So, in this era of electronic health records, I think one thing that’s extremely helpful is pharmacy records. So, we have many patients either on 30-day supplies or 90-day supplies. Therefore, their pickups should mirror their supply, and sometimes if we see we have a 30-day supply that’s picking up every 45 to 60 days, and similarly with 90-day supplies picking up every 120-plus days, gives us an indicator of missed pills. I also think that in our younger population, our adolescents and young adults, having them come in with either a family member, a loved one, a partner who can, can also help maybe, sometimes nonverbal communication. The patient will say that they’re taking their pills and you’ll see a shaking head behind them stating perhaps that’s not the case, just opens up the discussion of are there any issues that I could help you with or perhaps you’re not able to take your medication every day. So having that dialogue and sometimes an honest loved one who’s really advocating for the patient is helpful. 

DERRICK BUTLER, MD: In my practice, we’re not a research center. We don’t have access to certain sophisticated medication monitoring systems. Typically, the pharmacies that we have relationships with can be very helpful. Sometimes it’s calling, saying, did the patient get their medicine, did they receive it, or have your heard from the patient? Sometimes they’ll say, you know, the patient’s telling me they’re taking their meds, but yet the pharmacy says they haven’t picked up their meds in two months. So, it opens up kind of an avenue to try to address those issues with the patient. And I do, I like talking with family and partners. And I think it even goes back to the piece about adherence itself. It’s educating the families and partners about adherence for the patient, then helps you to use them as a tool going forward for their adherence.

LEANDRO MENA, MD: I agree. I mean, I think the family plays an important role in the support system of the patient. One thing is, sometimes I’m a little bit concerned is when patients develop this dependency in a relationship with families. When the mother or the aunt is the person who has to call them every day so they take their medication, and that’s something that I try to work over time. I help the patient understand that this is your condition. You are responsible managing it, because what’s going to happen when this person is not here? We all know that there are groups, you know, that are, you know, at high risk of being nonadherent, and I put in that group adolescents and young adults, and these are individuals that we want to make sure that we are more intense in terms of the support that we provide and how we monitor them. I mean, I call patients, you know, seven days after a prescription to make sure they filled the prescription. We call, you know, one month after, make sure that they are taking the medication, addressing if they have any side effects. I mean, every time I have a patient who comes and they take all the medication, I ask them, you know, tell me, how do you do it? What helps you? And that has helped me to develop a repertoire of strategies that I share with my patients. Some people put their medications on top of their cellphones, because that’s the first thing they do. Some people put them in their book bags. Some people put them behind or next to their toothbrushes. So, everyone has a strategy, and I think that as providers we are the depository of this community knowledge that we can share with our patients. 

CYNTHIA RIVERA, MD: Absolutely.