Even the most effective diabetes medications are useless if not taken as prescribed, making medication adherence a critical factor in achieving glycemic control and preventing long-term complications. Overcoming barriers to adherence is a complex challenge that requires pharmacists to use a variety of skills, from patient education and motivational interviewing to regimen simplification. As detailed in courses like Patient Care 5 and the Community IPPE, addressing adherence is a core professional responsibility. This quiz will test your knowledge on identifying barriers to adherence in patients with diabetes and implementing evidence-based strategies to improve it.
1. Medication adherence is best defined as:
- a. The act of the pharmacy dispensing a medication correctly.
- b. The extent to which a patient’s behavior corresponds with agreed recommendations from a healthcare provider.
- c. The patient’s ability to pay for their medication.
- d. The patient never experiencing any side effects from their medication.
Answer: b. The extent to which a patient’s behavior corresponds with agreed recommendations from a healthcare provider.
2. A patient with type 2 diabetes frequently forgets to take their metformin twice daily. This is an example of what type of non-adherence?
- a. Intentional
- b. Unintentional
- c. Cost-related
- d. Side effect-related
Answer: b. Unintentional
3. A patient deliberately chooses not to take their prescribed statin because they read online that it causes muscle pain. This is an example of:
- a. Intentional non-adherence based on health beliefs.
- b. Unintentional non-adherence.
- c. A system-related barrier.
- d. A cost-related barrier.
Answer: a. Intentional non-adherence based on health beliefs.
4. What is the most significant clinical consequence of poor adherence to diabetes medications?
- a. Lower healthcare costs.
- b. Poor glycemic control and an increased risk of long-term complications.
- c. Fewer side effects.
- d. The need for less frequent monitoring.
Answer: b. Poor glycemic control and an increased risk of long-term complications.
5. Which communication technique is designed to explore a patient’s own motivations for change and overcome ambivalence about adherence?
- a. A directive, authoritarian approach
- b. Motivational Interviewing (MI)
- c. Providing a pamphlet only
- d. Using only closed-ended questions
Answer: b. Motivational Interviewing (MI)
6. The management of diabetes, where adherence is a critical component, is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5784C Patient Care 4
Answer: a. PHA5787C Patient Care 5
7. A patient with a complex regimen of 12 medications due for refill on different days of the month is facing what type of barrier to adherence?
- a. A socioeconomic barrier
- b. A therapy-related barrier (regimen complexity)
- c. A patient-related barrier (health beliefs)
- d. An emotional barrier
Answer: b. A therapy-related barrier (regimen complexity)
8. Which pharmacy service can directly address the barrier of regimen complexity and multiple pick-up dates?
- a. Compounding
- b. Medication synchronization
- c. Providing a 30-day supply only
- d. Flavoring medications
Answer: b. Medication synchronization
9. The “teach-back” method is a useful tool to assess and improve a patient’s:
- a. Willingness to pay.
- b. Health literacy and understanding of their regimen.
- c. Level of motivation.
- d. Comorbid conditions.
Answer: b. Health literacy and understanding of their regimen.
10. A patient reports they often do not take their glipizide because they are afraid of their “sugar going too low.” This is a barrier related to:
- a. Cost
- b. Forgetfulness
- c. Fear of adverse effects (hypoglycemia)
- d. Regimen complexity
Answer: c. Fear of adverse effects (hypoglycemia)
11. Identifying and resolving adherence issues is a key objective in the Community IPPE.
- a. True
- b. False
Answer: a. True
12. Which of the following is an objective measure of medication adherence?
- a. Asking the patient if they take their medication.
- b. Calculating the Proportion of Days Covered (PDC) from pharmacy refill data.
- c. The patient’s A1c value.
- d. The patient’s self-reported log.
Answer: b. Calculating the Proportion of Days Covered (PDC) from pharmacy refill data.
13. A patient is prescribed insulin but has a severe phobia of needles. What type of barrier to adherence is this?
- a. Socioeconomic
- b. System-related
- c. Patient-related (psychological/emotional)
- d. Therapy-related
Answer: c. Patient-related (psychological/emotional)
14. Which of the following is an effective strategy to simplify a complex diabetes medication regimen?
- a. Adding more medications.
- b. Using combination products when appropriate.
- c. Switching all once-daily medications to three-times-daily medications.
- d. Using medications with more side effects.
Answer: b. Using combination products when appropriate.
15. Educating a patient on how to monitor their blood glucose is a key objective for student pharmacists and promotes adherence to monitoring.
- a. True
- b. False
Answer: a. True
16. A pharmacist using Motivational Interviewing asks, “What are some of the good things about taking your medication as prescribed?” This is an attempt to elicit:
- a. Sustain talk
- b. Resistance
- c. Change talk
- d. A history of the illness
Answer: c. Change talk
17. The Health and Wellness module for diabetes emphasizes Diabetes Self-Management Education and Support (DSMES), which is critical for adherence.
- a. True
- b. False
Answer: a. True
18. A patient cannot afford their brand-name DPP-4 inhibitor. This is an example of what type of adherence barrier?
- a. Health belief
- b. Psychological
- c. Socioeconomic (cost)
- d. Physical impairment
Answer: c. Socioeconomic (cost)
19. What is a pharmacist’s best first step when a patient expresses concerns about the cost of their diabetes medication?
- a. Tell them they must find a way to pay for it.
- b. Explore lower-cost generic alternatives with the prescriber.
- c. Suggest they stop taking the medication.
- d. Ignore their concern.
Answer: b. Explore lower-cost generic alternatives with the prescriber.
20. An active learning session on diabetes management, including adherence, is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A patient with a low level of health literacy may be non-adherent because:
- a. They do not care about their health.
- b. They do not understand the instructions or the importance of the medication.
- c. They are intentionally being difficult.
- d. They prefer natural remedies.
Answer: b. They do not understand the instructions or the importance of the medication.
22. Which of the following can help a patient who is forgetful?
- a. A weekly pill organizer.
- b. Setting daily phone alarms.
- c. Associating medication-taking with a daily routine, like brushing teeth.
- d. All of the above.
Answer: d. All of the above.
23. Counseling patients on new medications and adverse effects is a key objective in the Hospital IPPE.
- a. True
- b. False
Answer: a. True
24. An active learning session on diabetes is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A patient taking a once-weekly GLP-1 receptor agonist is more likely to be adherent than a patient taking a twice-daily injectable. This demonstrates how ____ can impact adherence.
- a. therapy-related factors (dosing frequency)
- b. patient-related factors
- c. socioeconomic factors
- d. system-related factors
Answer: a. therapy-related factors (dosing frequency)
26. The “S” in the OARS model of Motivational Interviewing stands for:
- a. Solution
- b. Sustain talk
- c. Summary
- d. Self-efficacy
Answer: c. Summary
27. To improve adherence to blood glucose monitoring, a pharmacist can:
- a. Counsel on proper technique to reduce pain.
- b. Explain what the numbers mean and how they can be used to make decisions.
- c. Discuss less painful testing sites (alternate site testing).
- d. All of the above.
Answer: d. All of the above.
28. An active learning session on diabetes is part of which course module?
- a. Module 1: Diabetes Mellitus
- b. Module 3: Women’s Health
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 1: Diabetes Mellitus
29. The concept of “diabetes distress” can be a barrier to adherence. It refers to:
- a. A fear of needles.
- b. The significant emotional burden and stress of living with and managing diabetes.
- c. A dislike for the taste of glucose tablets.
- d. An allergy to insulin.
Answer: b. The significant emotional burden and stress of living with and managing diabetes.
30. The management of diabetes complications is a topic within the Patient Care 5 curriculum, and adherence is key to prevention.
- a. True
- b. False
Answer: a. True
31. The first step to improving a patient’s adherence is:
- a. To identify that a problem exists and then explore the reasons for it in a non-judgmental way.
- b. To assume the patient is non-compliant and lecture them.
- c. To switch them to the most expensive medication.
- d. To call their physician and report them.
Answer: a. To identify that a problem exists and then explore the reasons for it in a non-judgmental way.
32. A patient-centered approach to improving adherence involves:
- a. The pharmacist making all the decisions for the patient.
- b. Collaborating with the patient to find solutions that work for their lifestyle and beliefs.
- c. Giving the patient a pamphlet and nothing else.
- d. Focusing only on the A1c value.
Answer: b. Collaborating with the patient to find solutions that work for their lifestyle and beliefs.
33. Social determinants of health, such as lack of transportation or food insecurity, can be significant barriers to diabetes adherence.
- a. True
- b. False
Answer: a. True
34. A patient with poor eyesight may have trouble accurately drawing up insulin doses. An appropriate intervention would be:
- a. Telling them to ask a family member for help.
- b. Suggesting an insulin pen device that clicks for each unit.
- c. Providing them with a magnifying glass.
- d. All of the above are potential interventions.
Answer: d. All of the above are potential interventions.
35. A pharmacist’s role in promoting adherence is a continuous process of:
- a. Assessment, intervention, and follow-up.
- b. Dispensing only.
- c. A one-time counseling session.
- d. Reporting non-adherent patients.
Answer: a. Assessment, intervention, and follow-up.
36. A patient is prescribed metformin and an SGLT2 inhibitor. The availability of a combination tablet (e.g., metformin/empagliflozin) can improve adherence by:
- a. Increasing the number of side effects.
- b. Reducing the patient’s pill burden.
- c. Making the medication more expensive.
- d. Increasing the dosing frequency.
Answer: b. Reducing the patient’s pill burden.
37. When using Motivational Interviewing, a pharmacist who says “It sounds like you’re finding it difficult to keep up with checking your sugar four times a day” is using:
- a. An open-ended question
- b. An affirmation
- c. A reflective listening statement
- d. A summary
Answer: c. A reflective listening statement
38. The lecture “Health and Wellness: Diabetes” covers self-management, a key to adherence.
- a. True
- b. False
Answer: a. True
39. A patient’s cultural beliefs about medicine can be a significant factor in their adherence.
- a. True
- b. False
Answer: a. True
40. An active learning session covering diabetes management is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. The best way to address a patient’s fear of hypoglycemia from their sulfonylurea is to:
- a. Tell them it’s not a real side effect.
- b. Educate them on the signs of hypoglycemia and how to treat it promptly with fast-acting carbohydrates.
- c. Advise them to always keep their blood sugar high.
- d. Immediately ask the doctor to stop the medication.
Answer: b. Educate them on the signs of hypoglycemia and how to treat it promptly with fast-acting carbohydrates.
42. Which of the following is NOT a barrier to medication adherence?
- a. Polypharmacy
- b. Low health literacy
- c. A strong, trusting relationship with the pharmacist.
- d. Cost of medication.
Answer: c. A strong, trusting relationship with the pharmacist.
43. A pharmacist providing a clear, simplified medication schedule (e.g., a chart) is helping to overcome which barrier?
- a. Cost
- b. Side effects
- c. Regimen complexity
- d. Fear of needles
Answer: c. Regimen complexity
44. If a patient is consistently non-adherent despite multiple interventions, the pharmacist should:
- a. Give up on the patient.
- b. Continue to offer support and explore new strategies in a non-judgmental way.
- c. Refuse to dispense their medications.
- d. Blame the patient for their poor health outcomes.
Answer: b. Continue to offer support and explore new strategies in a non-judgmental way.
45. Adherence to lifestyle modifications (diet, exercise) is just as important as medication adherence in diabetes management.
- a. True
- b. False
Answer: a. True
46. “Diabetes Self-Management Education” is a lecture in the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
47. A pharmacist can use pharmacy refill data to:
- a. Diagnose diabetes.
- b. Identify patients who may be non-adherent (e.g., late refills).
- c. Prescribe insulin.
- d. Change a patient’s diet plan.
Answer: b. Identify patients who may be non-adherent (e.g., late refills).
48. An active learning session on diabetes is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
49. The “A” in the OARS model stands for Affirmation. An example for a patient who checked their blood sugar is:
- a. “What was your number?”
- b. “You should check more often.”
- c. “It’s great that you’re taking that step to monitor your health.”
- d. “Is your meter working correctly?”
Answer: c. “It’s great that you’re taking that step to monitor your health.”
50. The ultimate reason to focus on improving adherence in diabetes is to:
- a. Increase pharmacy sales.
- b. Help patients achieve better glycemic control and reduce their risk of devastating long-term complications.
- c. Make the A1c value look better on paper.
- d. Fulfill a quality metric for insurance companies.
Answer: b. Help patients achieve better glycemic control and reduce their risk of devastating long-term complications.