Triggers

Enhancing Patients’ Treatment Adherence

So much human behavior is not based on conscious thought but on automatic programming.  For example, when I go to work each morning, I get to the bottom of the drive way and turn left.  On Saturday morning, my son and I go to Tae Kwon Do together.  To get there, I have to turn right.  He and I get in our uniforms, we get in the car, we intend to go to Tae Kwon Do, but when I get to the bottom of the driveway, I turn left.  Automatically.  Of course I consciously want to go to Tae Kwon Do, but my automatic behavior is far more powerful than my conscious thinking. 

There are no pockets in my Tae Kwon Do uniform, so while at class, I keep my wallet and cell phone in a locked compartment in the car.  As I walk to the car after class, I tell myself, “Steve, when you get in the car, unlock the compartment before you start the car so you can get to the cell phone if you need to.”  As I unlock the car door just before getting in the car, I remind myself, “Steve, when you get in the car, don’t forget to unlock the compartment before you put the keys in the ignition so you can get to the cell phone if you need to.”  Then, I get in the car, put the keys in the ignition, start the car and realize, “Darn it!  I forgot to unlock the locked compartment!”

When we give patients a new medication to use, we are asking for a new behavior.  Until that behavior becomes part of the routine, it is all too easy to forget.  One way to help get past this problem is to give patients a trigger for using the medication.  A trigger is some event that will cause patients to remember to use their medication.

The ideal trigger will help the patient build the use of their medication into the automatic activities that they already do.  Perhaps the best example of this is getting patients to put on an anti-fungal cream for their athlete’s foot.  If we have patients put the cream in the dresser drawer right on top of their socks, they will see the medication and be triggered to use it right when they need it, before putting their socks on.  If they put the medication anywhere else, I would almost guarantee you that their automatic behaviors will cause them to put their socks and shoes on first, then remember they need to use the medication, at which point they will say, “Ah well.  It is too much trouble to take the shoes and socks off.  I’ll use the medicine tomorrow.

If we get patients to the point where taking their medication is automatic, we are golden.  Depending on them to use conscious thought to get them to use medication is not a reliable strategy—even if we’ve educated them and given them written instructions on proper medication use.  Until taking medication becomes a habit, we must depend on something else to trigger their use of the medicine.

Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com and author of “Compartments” (www.compartmentsbook.com).