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Almost one-half of patients prescribed psychotropics do not take recommended dosages, but interrogating them can make them defensive and compromise your therapeutic alliance. When a patient resists starting a psychotropic, targeted interventions tied to a medication-specific transtheoretical approach can help.
Stages of change
Willey et al1 validated Prochaska and DiClemente’s stages of change2 for patients prescribed medications. Their modification provides quick assessment of how ready a patient is to commit to taking medication.
If your patient does not start a psychotropic, acknowledge that some find it difficult to take medication as directed. After you determine the patient’s stage of change, I suggest that you tailor interventions to match that level (Table), then work toward the action stage: commitment to adherence.
With stage-specific interventions, patients feel empowered to make their own decisions, rather than coerced or pressured to take medications.
Table
Assessing readiness to start medication
| Stage of change2 | Patient statement | Suggested interventions |
|---|---|---|
| Precontemplation | I do not intend to take the medication as directed |
|
| Contemplation | I intend to take the medication as directed, but not right now |
|
| Preparation | I plan to take the medication as directed in the near future |
|
| Action | I am ready to take the medication as directed |
|
1. Willey C, Redding C, Stafford J, et al. Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure. Clin Ther 2000;22(7):858-71.
2. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward and integrative model of change. J Cosult Clin Psychol 1983;51:390-5.
Deborah S. Finnell, is a board-certified nurse practitioner in psychiatric mental health nursing and addictions nursing at Canandaigua VA Medical Center and assistant professor of nursing, State University of New York, Buffalo.
Almost one-half of patients prescribed psychotropics do not take recommended dosages, but interrogating them can make them defensive and compromise your therapeutic alliance. When a patient resists starting a psychotropic, targeted interventions tied to a medication-specific transtheoretical approach can help.
Stages of change
Willey et al1 validated Prochaska and DiClemente’s stages of change2 for patients prescribed medications. Their modification provides quick assessment of how ready a patient is to commit to taking medication.
If your patient does not start a psychotropic, acknowledge that some find it difficult to take medication as directed. After you determine the patient’s stage of change, I suggest that you tailor interventions to match that level (Table), then work toward the action stage: commitment to adherence.
With stage-specific interventions, patients feel empowered to make their own decisions, rather than coerced or pressured to take medications.
Table
Assessing readiness to start medication
| Stage of change2 | Patient statement | Suggested interventions |
|---|---|---|
| Precontemplation | I do not intend to take the medication as directed |
|
| Contemplation | I intend to take the medication as directed, but not right now |
|
| Preparation | I plan to take the medication as directed in the near future |
|
| Action | I am ready to take the medication as directed |
|
Almost one-half of patients prescribed psychotropics do not take recommended dosages, but interrogating them can make them defensive and compromise your therapeutic alliance. When a patient resists starting a psychotropic, targeted interventions tied to a medication-specific transtheoretical approach can help.
Stages of change
Willey et al1 validated Prochaska and DiClemente’s stages of change2 for patients prescribed medications. Their modification provides quick assessment of how ready a patient is to commit to taking medication.
If your patient does not start a psychotropic, acknowledge that some find it difficult to take medication as directed. After you determine the patient’s stage of change, I suggest that you tailor interventions to match that level (Table), then work toward the action stage: commitment to adherence.
With stage-specific interventions, patients feel empowered to make their own decisions, rather than coerced or pressured to take medications.
Table
Assessing readiness to start medication
| Stage of change2 | Patient statement | Suggested interventions |
|---|---|---|
| Precontemplation | I do not intend to take the medication as directed |
|
| Contemplation | I intend to take the medication as directed, but not right now |
|
| Preparation | I plan to take the medication as directed in the near future |
|
| Action | I am ready to take the medication as directed |
|
1. Willey C, Redding C, Stafford J, et al. Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure. Clin Ther 2000;22(7):858-71.
2. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward and integrative model of change. J Cosult Clin Psychol 1983;51:390-5.
Deborah S. Finnell, is a board-certified nurse practitioner in psychiatric mental health nursing and addictions nursing at Canandaigua VA Medical Center and assistant professor of nursing, State University of New York, Buffalo.
1. Willey C, Redding C, Stafford J, et al. Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure. Clin Ther 2000;22(7):858-71.
2. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward and integrative model of change. J Cosult Clin Psychol 1983;51:390-5.
Deborah S. Finnell, is a board-certified nurse practitioner in psychiatric mental health nursing and addictions nursing at Canandaigua VA Medical Center and assistant professor of nursing, State University of New York, Buffalo.