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Chelsea Lujan Counselor’s Role with Client Regarding Medication Noncompliance COUN-6743 Psychopharmacology Professor Amy Cook October 23, 2023

Introduction Medication adherence is a common factor in the lives of people who are living with illnesses that depend on medications. There is a known knowledge by the doctors who treat patients with chronic illnesses that require medication at a constant rate but because of their medication adherence, there is not much medical professionals can do to decrease the rate. The control of this nonadherence has nothing to do with the medical professional directly but with the healthcare system as a whole ( Kleinsinger, 2018) . People would say it is the patient's fault but the lack of certain interventions to be in place to help the community is non-existent. Change can happen but requiring the right planning and movement of healthcare systems to also take forth the change. There are many barriers to medication adherence and four of the main ones to point out are fear, cost, misunderstanding, and other mental factors that affect moods. Four Reasons for Medication Nonadherence Fear The rationale for an emotion like fear to come into the minds and lives of the patients knowing that they need the medication shows a lack of understanding. Medication is constantly being developed for many different issues and at times people are prescribed more than they expected with unexpected side effects that worsen the adherence to the medication. The effects of medication absorption or if responding to the medication is due to work. People of certain groups are not at the top of the most desirable of these possible side effects. The group of people consists of senior citizens, people who are battling with diseases, women who are pregnant, young children, and those who have hereditary factors (Engelen, 2021). When people are not sure what they are putting in their body regardless if there is a medical professional explaining

the benefits. As medical professionals, they are obligated to inform the patient of all possible side effects to decrease the fear and help in the best way possible. People tend to hear the horror side of medications from others who have received them and make that their ultimate reason as to why they won't take medication (Engelen, 2021). Cost The rise in cost affects all areas of the medical field. Patients are given exams that lead to finding out what medical issue they have and end with what treatment is needed. Cost is everywhere in the medical field including the cost of medications. Also depending if insurance is willing to cover at least part of it. The unlikely chance of getting it entirely off the medication, unless you have good insurance, is unlikely. The “estimated approximately 50% of patients may not be taking their medications as prescribed due to cost” (Rohatgi et al., 2021). The cost of medication has skyrocketed through the roof and if you were to ask low-income people if they are choosing basic needs like food, clothing, or housing over medication. They are going to choose the necessities. People should not be put in the situation of choosing their basic needs over the prescribed medication to help their medical issues. People are paying out of pocket to pay for high-value medication and that is destroying the overall health of the individual. Mistrust The medical field is vastly large and is responsible for the lives of patients, especially those who require certain medical needs. At the same time physicians and medical professionals are put in the position to all for the best medication possible. Yet if the physician can prescribe certain medication to the patient say between two brands one which is more expensive it helps the patient and an off-brand that has the same effect but is cheaper the physician is most likely to

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choose the better brand. The pharmaceutical companies make a drug that will produce more money and the doctors are receiving a certain amount they are more likely to prescribe to the patient (Ornstein et al., 2016). The generic has been proven to work just as the top-named brand and for certain medications that do not have a generic brand but have similar ones. So where is the mistrust exactly in all this? If the doctor knows of a generic brand for the patient is unable to afford the top brand and does not know they are both effective. There is dishonesty due to the lack of allowing the patient to have a choice to look for options. The doctor could and would prescribe the expensive one knowing they are going to get a check from that pharmaceutical company. Depending on which state, pay can be in the high thousands (Ornstein et al., 2016). Other Mental Factors that affect mood There are times when a patient is in a state of depression or mental illness that does not allow themselves to want to take medications. There are many factors why a patient does not want to take their medications. The valid reasons such as mentioned previously are valid. We also have to consider the mental state in which the patient may be. There are times when determining psychological components of why clinically ill personnel have medical adherence ( Bąk-Sosnowska et al., 2022). People get stressed and emotional knowing the effects of medications and how their lives are altered. Avoidance is true to nature when we as people do not want to deal with stressful situations or things that become too complicated. Yet we tend to overlook that health decisions may affect our physical it also affects mental decisions (Bąk- Sosnowska et al., 2022). Systemic Barriers to Medication Adherence

The social status of well-being is looked at as something that everyone needs to accomplish. If you are not doing well in any aspect of life, you tend to be overlooked and labeled differently by those with opinions. There is a negative view and stigma to mental health and taking medication worsens the look of the client. Human nature is to seek perfection or the best they can be for themselves. Culture is a great example of medication adherence. People have different reasons for abstaining from medication in general some cultures frown upon taking pills to treat illness. In the Hispanic culture, people tend to rely on their kids to help them access medication. A language barrier because a family or an individual is unable to tend to the doctor what they need. Although interpreters are available, a lot of the information from patient to interpreter to doctor gets lost in translation (McQuaid & Landier, 2018). This leads to a decrease in the intake of medication being distributed to communities like this. Techniques to Improve Adherence Counselors are to support their clients and help in the way the client is willing to allow the help to help. This is noticeable in the acts the client may want to partake in and what medication they also think is best for their health. Education is key to understanding what and why this specific medication is going to benefit them. Fear has prompted a lot of people to not reach for medication because they are not aware of how it is going to affect them. Understanding the position, the client is vulnerable to the fact they are trying to help their health by treating them with medicine. Techniques to Decrease Adherence Counselors need to point out the initial reasons for the adherence. There are ways to personalize a treatment for the client it creates the plan for that particular person. The medical

system also could improve the accessibility to healthcare as it can bring forth positive outcomes. Doctors in the general sense can accept patients of all statuses not just accept the patients who bring in more money. Collaborations between doctors and pharmacists and monitoring the drug administration. Also, where the patient pays out of pocket can overwhelm the patient doing a better job to allow the prescription of generic brands (Melet, 2023). How would you be in the client’s shoes about the use of medication? Upon doing the research and understanding the reasoning behind the use of medication I would want the best possible. I would want the counselor to take notice of my needs and if I really would benefit from medication. I want to take alternative measurements before leaning towards medication. I would not want to spend it out of pocket. I had necessities that can take over a pay and trying to take care of myself with medication makes it harder. I would want my counselor to exhaust all options possible to make sure I am mentally prepared to make a big decision.

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Reference: Bąk-Sosnowska, M., Gruszczyńska, M., Wyszomirska, J., & Daniel-Sielańczyk, A. (2022). The Influence of Selected Psychological Factors on Medication Adherence in Patients with Chronic Diseases. Healthcare , 10 (3). https://doi.org/10.3390/healthcare10030426 Engelen, K. (2021, March 31). How the fear of medication side effects impacts adherence. October 29, 2023, https://rxlive.com/blog/medication-adherence-side-effects/ Kleinsinger F. (2018). The Unmet Challenge of Medication Nonadherence. The Permanente journal , 22 , 18–033. https://doi.org/10.7812/TPP/18-033 McQuaid, E. L., & Landier, W. (2018). Cultural Issues in Medication Adherence: Disparities and Directions. Journal of General Internal Medicine , 33 (2), 200- 206. https://doi.org/10.1007/s11606-017-4199-3 Melet, J. (2023, January 27). Strategies to improve medication adherence . Acare HCP Global. https://acarepro.abbott.com/articles/general-topics/strategies-improve-medication- adherence-treatment/ Ornstein, C., Tigas, M., & Grochowski Jones, R. (2016, March 17). Dollars for doctors. ProPublica . Retrieved October 29, 2023, from https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe- more-brand-name-drugs. Rohatgi, K. W., Humble, S., McQueen, A., Hunleth, J., Chang, H., Herrick, C., & James, A. S. (2021). Medication adherence and characteristics of patients who spend less on basic

needs to afford medications . Journal of the American Board of Family Medicine : JABFM, 34(3), 561. https://doi.org/10.3122/jabfm.2021.03.200361

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