Module 2: Core CHW Competencies › Lesson 2.3 · 7 sections · ~35 min

Medication Reconciliation

Learning Objectives

Describe the importance of sticking to a medication regimen and the potential harms of not doing so.
Name the common barriers to medication adherence.
Describe the three pillars of improved medication adherence and strategies for each.

Why medication management matters

Medications are essential for treating chronic conditions — but only when taken correctly. Medication management is the process of making sure patients are taking the right medicines, in the right way, and that those medicines are working well for them.

CHWs are uniquely positioned here. You know the patient's home, culture, and habits. You can find what's actually stopping someone from taking their medicine, then bridge them to their healthcare providers.

Case Study

JamesAge 58 · Tradesman · Living with rheumatoid arthritis and high cholesterol

Situation

Each day, James faces a strict medication regimen for his chronic conditions. The side effects of his arthritis medication — fatigue and nausea — make it tempting to skip doses when he needs to finish a job. The financial burden of his cholesterol medication leads him to occasionally ration his pills.

What the CHW Did

James experiences fluctuations in his health — periods of increased joint pain and elevated cholesterol — affecting his ability to make a living and his overall well-being.

Outcome

James is who we're going to learn how to help. The rest of this lesson is the toolkit.

What we mean by adherence

When a patient follows the doctor's instructions for taking medicine, it's called medication adherence. A medication regimen is the plan that tells the patient how much medicine to take and when.

To follow the regimen, the patient needs to:

Fill their prescriptions
Remember when to take their medicine
Know how to take it properly

When patients don't follow the instructions — like James above — it's called medication nonadherence. Nonadherence can make the condition worse, often requiring more medicine taken more often, which makes adherence even harder.

Poor patient understanding of medication instructions and adherence is an important contributor to the more than 1 million medication errors and adverse drug events that lead to office and emergency room visits, hospitalizations, and even death.
— Academies of Sciences, Engineering, and Medicine (2017)

What happens when people don't take their medications

Nonadherence is a major risk, especially for older adults.

Effects of medication nonadherence

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Dizziness

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A common consequence of inconsistent dosing or interactions.

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Why patients don't take their medications

There are many reasons individuals find it challenging to take their medications correctly.

Barriers to medication adherence

Knowledge Check — Select all that apply

Sofia is a 45-year-old single mother with type 2 diabetes, working two jobs to support her family. She often forgets to take her medication due to her hectic schedule and sometimes skips doses because of side effects, including nausea and dizziness. Sofia has expressed concerns about these side effects to her healthcare provider but feels her concerns are not taken seriously. Which factors pose a barrier to Sofia's medication adherence? Select all that apply.

Socio-economic factors

Therapy-related factors (side effects: nausea, dizziness)

Patient-related factors (forgetfulness from a hectic schedule)

Condition-related factors

Health system / care team-related factors (provider not taking concerns seriously)

Note

Some barriers are easier to fix than others. Forgetfulness might be solved with a simple plan. Cultural beliefs about medication are much harder. As a CHW, you're often the only person who takes the time to listen and understand — and then advocate for the patient with their medical team.

How CHWs assess adherence

To help patients with their routines, CHWs need to find out if patients are actually taking their medication as prescribed. Talk to them, check their home, or use formal assessments.

MAQ — Medication Adherence Questionnaire

Also known as the 4-item Morisky Medication Adherence Scale (MMAS-4). A self-reported questionnaire that assesses a patient's beliefs, concerns, and behaviors around their medications.

PAM — Patient Activation Measure

A self-reported questionnaire that assesses a patient's knowledge, skill, and confidence for managing their own health and healthcare — including medications.

Medication Reconciliation

CHWs use medication reconciliation to surface where patients have trouble taking their medications as prescribed, then work with the patient and care team to come up with solutions. To reconcile, we identify:

The names of the medications
The dosages
The frequency they're prescribed
How they should be taken (swallowed, sublingual, topical, etc.)

A pharmacist then reviews the full list with the patient's conditions to check for issues — side effects, interactions, or signs of nonadherence.

The three pillars

Three main strategies CHWs use to help patients take their medications correctly.

The three pillars of medication adherence

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Address Patient Behavior

Educate the patient about their condition and how/why to take their medications. Works when the patient can get the medication but has a hard time taking it as prescribed.

Knowledge Check

A patient has been prescribed a medication that causes increased urination. The patient doesn't take it when on the road, since it can be hard to find a restroom. The CHW helps the patient and their doctor have a conversation about other options. Together they decide to change to a medication that doesn't cause frequent urination. Which pillar of medication adherence did the CHW use?

AAddress patient behavior

BImprove drug regimen

CReduce cost barrier

Practical strategies for improving adherence

Strategies for reducing cost barriers

Cost might feel like the hardest barrier, but there are real tools available. CHWs can:

Check if the patient qualifies for insurance they don't currently have
Inform the patient about mail order, employee medication assistance, and government/insurance-sponsored prescription assistance programs
Research prescription drug discount cards
Look into drug company patient assistance programs
Check consumer reports
Explore health insurance counseling/advocacy programs
Consult the California Health Advocates program (for Medicare beneficiaries)

Tip

Every fall, Medicare beneficiaries can enroll in a Part D prescription drug plan. The Medicare Plan Finder website (medicare.gov/plan-compare) lets you enter the patient's medications and find a Part D plan that minimizes their out-of-pocket costs.

Case Study

AnonymousAge 83 · Difficulty walking · Falls linked to a hidden medication problem

Situation

The patient had fallen multiple times. The cause wasn't obvious.

What the CHW Did

Worked with the medical team to do a medication reconciliation.
Discovered an over-the-counter medication the patient was taking was increasing his fall risk.
Helped the patient stop taking it (in coordination with his providers).
Helped him get steadiness aids — a walker, grab bars in the bathroom.
Connected him to a program to learn fall-prevention skills and techniques.

Outcome

Lower fall risk, safer home environment, and skills for preventing future incidents. A reminder that medication management isn't just about adherence — sometimes it's about catching what's wrong on the list.

Lesson Takeaways

🌟 Lesson takeaways

Not taking medicine as prescribed harms patient health and makes treatment harder. CHWs are uniquely positioned to figure out why and to help. Remember the three pillars: address patient behavior, improve drug regimen, and reduce cost barriers.

🎉Great work!

📅

Coming up

Great work! At the end of this module, you'll join a live discussion with your cohort and an instructor. We'll see you there.

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