CASE EXEMPLAR: Patient With Medication Nonadherence MO is a 45-year-old African American male with c

CASE EXEMPLAR: Patient With Medication Nonadherence MO is a 45-year-old African American male with chronic asthma and obesity who presents with a chief complaint of knee pain. Additionally, he reports symptoms of depression. MO has been prescribed two medications for his asthma (one corticosteroid inhaler for long-term control and one bronchodilator, a rescue inhaler). He voluntarily reports that he is taking his medication exactly as prescribed. In addition to treating his chief complaint, the clinician tells MO that they will further evaluate his depressive symptoms and may be able to prescribe an antidepressant. MO discloses that his work situation is not consistent, and he has tried Prozac in the past and it didn’t work. The clinician queries, “Can you please tell me how you are taking your two asthma medications?” MO responds, “I take my Flovent HVA (long-term steroid inhaler) twice a day, and my Ventolin (beta-2 antagonist rescue inhaler) one inhalation a day when I feel wheezy.” This provides an opportunity for the clinician to assess MO’s health literacy by asking him to clarify what twice a day means for him. MO responds, “I take two puffs in the morning of the Flovent.” The clinician acknowledges what MO’s interpretation of “twice a day” means to him; however, he clarifies in easy-to-understand terms that the Flovent should be taken two times a day, 12 hours apart. The clinician suggests, “You can take one inhalation first thing in the morning before you brush your teeth, and then again 12 hours later (usually at bedtime) before you brush your teeth.” The clinician then uses the same process to clarify the use of Ventolin and explain in layman’s terms that the Ventolin is to be used only for an acute attack (not daily), one to two inhalations every 4 to 6 hours. The clinician asks MO to repeat this information to confirm understanding. MO discloses that it may be hard for him to remember to take his Flovent in the morning and before bedtime. This is an opportunity for the clinician to utilize motivational interviewing. The clinician asks MO, “Can you think of some ideas that may help you take your Flovent medication as prescribed?” This allows MO to take autonomy of the situation and come up with a solution that best suits his lifestyle. MO suggests, “I can put the inhaler by my toothbrush because I brush my teeth in the morning and before bed, and I can put a note on my Ventolin to only use when I need it.” The clinician can now take the time to circle back to address MO’s feelings of depression and past experience with Prozac, again utilizing the five As. The clinician begins by assessing any barriers and beliefs to antidepressants by asking, “When you started taking Prozac, did you miss any doses?” This provides knowledge about how MO took the medication. The clinician can then review with MO that the antidepressant medication works best if taken at the same time every day, feelings of change in mood may not be immediate, and it can take up to 3 months to notice an effect. The clinician then continues with the remaining A’s to not only promote patient centeredness, but also assist in MO’s success for medication adherence. Additionally, the clinician uses this time to address and review possible side effects, investigate MO’s financial situation by using nonjudgmental questions, and provide resources for access to either free or discounted medications. Discussion Questions 1. How should the clinician classify MO’s nonadherence, and what additional interventions should the clinician employ to assist this patient? 2. Outline anticipated interactions the clinician may have with this patient using the following three A’s: Agree upon clear goals for medication use, assist in addressing barriers and securing social support, and arrange follow-up meeting.

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