In this podcast episode, Lorry talks with Keith Courtney, DO, CCHP, Alberta Health Services Facilities – Medical Director for Correctional Health Services, in Alberta, Canada. He and his colleagues (Dr. Lauren Cuthbertson, Dr. Karolina Koalewski, and Dr. Jennifer Edge) have published the article Factors that Promote and Hinder Medication Adherence from the Perspective of Inmates in a Provincial Remand Center: A Mixed Methods Study in the January 2018 issue of the Journal of Correctional Health Care.

Factors that promote and hinder medication adherence

Assuring that patient take medication as prescribed and on schedule can be challenging in a care setting where the environment is not set up for health care delivery. Understanding the factors that help or hinder medication adherence is an important part of any improvement plan. As there is little in the published literature about medication adherence in correctional settings, Dr. Courtney and colleagues interviewed 17 male and 3 female inmates in a Canadian provincial remand center (jail) to determine themes in medication adherence factors. They analyzed themes from participant narratives along with data analysis of two validated scales and data extracted from medical records. Thus, this research included both qualitative and quantitative components (mixed methods).

Themes in the research results were categorized as patient-related, provider-related, and correctional setting factors.

Promoting Medication Adherence

• Patients more likely to take their medications were those with less addiction, more social support and a greater understanding of their condition and the effect of the medication.
• Providers who were judged to be understanding, mutually respectful, and a good listener promoted medication adherence.
• Flexibility in the correctional environment also encouraged medication adherence.

Hindering Medication Adherence

• Patients who were less likely to take their medications included those with mental health conditions and/or using illicit drugs.
• Providers perceived to be poor listeners, judgmental, and disrespectful hindered medication adherence.
• Inconvenient and erratic medication delivery times also discouraged medication adherence.

While this Canadian study had a small sample that affects generalizability, it does reiterate the positive health care provider and system attributes that facilitate a healthy healthcare relationship and encourage medication use. The researchers conclude that “the principles of compassionate and patient-centered care that are articulated by the professional bodies of all health care providers mean there is a professional obligation to seek to improve the quality, experience, and outcomes of care” in correctional settings.

How are you handling medication adherence in your setting? Share your thoughts in the comments section of this post.