Medication adherence and treatment fatigue — formative SAQs

SAQ 1 — Assessment and measurement (10 marks)

A 15-year-old with epilepsy has been seizure-free for two years on a single antiseizure medicine. At review the level is subtherapeutic; the young person reports taking every dose and asks whether they can stop now that they feel well. [1] [4]

Questions

1. Define medication adherence and distinguish its three phases. (3 marks) [3]
2. Outline how you would assess adherence in this young person, naming the modalities and their limitations. (4 marks) [1] [4]
3. Explain the principle behind the young person's request to stop, and your immediate non-pharmacological response. (3 marks) [1] [5]

Model answer

Definition and phases (3). Adherence is the extent to which a person's behaviour in taking medication corresponds to agreed recommendations. It has three phases: initiation (whether the medicine is ever started), implementation (whether it is taken as prescribed day to day), and persistence (whether it is continued over time). A subtherapeutic level with reported perfection is an implementation failure until shown otherwise, and the request to stop is a persistence question. [3] [1]

Assessment (4). Open with a non-judgemental, normalising frame and time alone. Take a structured, behavioural history (of the last seven days, how many had all doses). Measure multimodally: self-report opens the conversation; refill or pharmacy records estimate implementation over time; the drug level and any objective data triangulate it, while recognising white-coat adherence can raise a pre-visit level and mask chronic non-adherence. Screen for mood and the meaning of the medicine. No single measure captures the whole behaviour. [1] [4]

Request to stop (3). This is the asymptomatic-on-treatment trap: success of the medicine removes the symptoms that signalled its necessity, so the young person reasons it is no longer needed. Withdrawal risks seizure cluster and raises sudden unexpected death in epilepsy risk. Respond with curiosity rather than confrontation — explore what stopping would mean, share the rationale for continuation, and build a shared plan rather than issue an instruction. [1] [5]