Medication History
A complete and accurate medication list is a critical part of the history. Sixty percent of American adults take at least one daily medication, and fifteen percent take five or more. Current medications must be reviewed to ensure a new therapy won’t interact with any of them, and many symptoms can be caused by a side effect. Medications are also a common source of confusion and error.
As with other parts of the history, start with an open question, like “What medications do you take?” and follow up with focused questions to learn the dose, frequency, and indications for each medication.
- Do you know what the dose is?
- How many times a day do you take it?
- What is that medication for?
Tip 1. Cross-reference the PMH and the medication list.
If the patient hasn’t mentioned a therapy for an ongoing issue, ask how they are treating it. Eventually, you’ll know what medications a patient should be taking to treat their diagnoses – you can ask specifically about these.
- Do you take anything for your high blood pressure?
- Are you on a statin for your cholesterol?
Tip 2. Ask specifically about over-the-counter medications.
People often assume these are safe since they are available without a prescription, but many have serious side effects and drug interactions. Acetaminophen (Tylenol) can cause liver failure, ibuprofen can cause ulcers, and antihistamines can cause confusion and inability to urinate.
- Do you take any medications that you can buy without a prescription, like ibuprofen or allergy medicine?
Tip 3. Ask specifically about herbal medications and supplements.
Like prescribed medications, these can be effective in treating some conditions and can also be associated with drug interactions and side effects.
- Any supplements or herbal medications?
- Any other treatments that you use?
Finally, ask about any allergies to medications. For each, ask specifically about the reaction that your patient had – some are minor and some might not be allergies at all. This is especially important for antibiotics, which might be needed emergently.
Assessing adherence
Medication nonadherence is responsible for nearly one third of ER visits and at least 10% of hospital readmissions. Research shows that one out of every five new prescriptions is never even filled, and of those that are, only half are taken as prescribed. Medication adherence has important consequences. For example, in patients with chronic heart disease, adherence is associated with fewer hospital admissions, lower mortality, and lower healthcare costs. In diabetes, adherence to glucose lowering therapy is associated with fewer ED visits, hospitalizations, and acute complications of diabetes
Screen for nonadherence by asking “Have you missed any medication doses in the past week?” or “How many medication doses do you usually miss in a week?”
If doses are missed, start by thanking your patient for telling you. Then explore possible reasons in an open and nonjudgmental way. There’s no one size fits all solution to improving adherence so you need to understand the ‘why’ for your patient. Common reasons for medication nonadherence are the 3C’s: cost, complexity of the regimen, and concerns about specific side effects or about taking medications in general.
You might wonder if there are ways to improve adherence to medications. Research shows that patient-centered care using communication skills that focus on rapport building and the patient perspective improve medication adherence. Just another example of the impact of communication skills on health!
References & resources
Driever EM, Brand PLP. Education makes people take their medication: myth or maxim? Breathe (Sheff). 2020 Mar;16(1):190338. doi: 10.1183/20734735.0338-2019. PMID: 32194770; PMCID: PMC7078734.
Free interactive module. Medication Adherence: Improve Patient Outcomes and Decrease Cost