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Are you a healthcare practice considering using blood tests to confirm that your patients are adhering to their medications properly? Here are some factors to consider.
Your patient is showing no signs of improvement for their serious hypertension after being prescribed high blood pressure medication and placed on a low-sodium diet. They promise they are sticking to their required diet, even showing you their food diary, but something is not adding up. Even without a diet change, the medication should have lowered their blood pressure by now.
Here is where things can get sticky. You can choose to trust your patient that they are sticking to their medication plan and assume that there is another diagnostic reasoning. But this could lead to serious complications if the reasons they were not showing improvement were based on their nonadherence. Should you order a blood test to confirm?
Using blood tests to confirm medication adherence may seem like the best and most reliable way to assess adherence, but this method has its own pros and cons.
When to Use Blood Tests to Confirm Medication Adherence
While blood tests are not necessary for every patient, they can be helpful in specific situations, particularly ones where you need to know exactly what is happening in a patient’s body at that very moment. Blood tests can beexcellent for testing whether a patient has taken a prescribed medication in the past 24 hours. They can provide a clear picture of drug levels in their system, making it more reliable than just taking a patient’s word for it, especially when controlled substances are involved.
If a patient’s symptoms are not improving as they should be, you may be forced to assume the current diagnosis is incorrect and order new tests to reassess the situation. However, if a blood test shows the patient simply is not taking their medication as ordered, you can avoid the costly and time-consuming need to re-evaluate or use observation-based therapy methods, such as inpatient treatment.
For certain medications, like blood thinners, heart medication, or opioids, having too much or too little in the blood can be dangerous. Using regular blood tests to ensure medical adherence helps make sure the patient is taking a medicinal dose, but not so much that it becomes toxic.
The Problem with Measuring Medication Adherence
In research done by Vik et al. (2004), trends of medication adherence were studied across databases like MEDLINE and PubMed. They found that although many assessment strategies exist, the medical field lacks a recognized standard for tracking patients’ adherence to prescription guidelines. From biological tests like tracking medication in blood and urine to self-reporting and pill counting, these methods all have benefits and risks.
Biological Tests
Biological tests check for the concentration of a drug or other indicators of the medication through a blood or urine sample. These tests can be costly and may feel invasive to the patient. If there is any time between the test being ordered, the patient could take their medication, causing the tests to give an incorrect result.
Manual and Self-Reported Tests
Other options to measure adherence include counting a patient’s remaining pills, checking pharmacy records, and direct patient interviews. While these methods are less costly than biological testing, patterns of over- and underuse of medications cannot be tracked.
Electronic Medication Tracking
Special pill bottles, like the Medication Event Monitoring System (MEMS), allow for noninvasive tracking of medication adherence. They do this by electronically monitoring pill usage (through weight) and record the date and time of a pill bottle being opened and closed. This remains a relatively new system, so its availability and cost could be prohibitive.
When Blood Testing Should Not Be Used
The bond you create with your patient is important. When requiring a blood test to confirm that they are taking medication correctly, this may feel like an invasion of their privacy or that you are policing them. Rather than helping them, it can cause a break in your established relationship.
If you are able, it may be best to hold off on using blood testing until you are sure it is necessary. Start by having an up-front and honest conversation with your patient. Explain that you are trying to help them get better and your concerns regarding their well-being if they do not take their medication properly. This direct connection may help encourage them to be upfront about their adherence to their prescribed medication dosing and allow them to avoid this costly test.
Are Blood Tests to Confirm Medication Adherence Legal?
Yes, in many cases, it is legal to use blood tests to see whether a patient is following their prescribed medication plan. Just as with other tests, the patient has the choice of whether to get the testing you request. If a patient refuses the test, you will still have to decide whether to end their medication refills or take another course of action.
Informed Consent with Blood Testing
When you require your patient to take a blood test, be sure to explain why the test is necessary to comply with Informed Consent Laws. If you do not fully explain why the test is necessary, it could lead to both legal and ethical problems. Blood tests can be expensive, and testing for medication adherence can be avoided if the patient is upfront and honest about the way they have been taking it.
For full transparency with your patient, outline why you need to order this blood testing and what you will do after the test if they do not take their medication as prescribed. Knowing that you have a plan of action in place may encourage your patient to admit to taking their medication incorrectly and avoid the need to do testing at all.
Remain Compliant with the Latest Medical Laws
If you want to create a clear policy for your office regarding blood testing and patient rights that keeps you legally protected, Jackson LLP Healthcare Lawyers can help. We help you stay on top of the latest medical laws and provide strategic guidance when you need it.
If you are in one of the states where we have licensed attorneys, you can schedule a free initial consultation to have your legal questions answered and learn how we can help your practice.
This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.
