DRAW: A Great Tool for Fostering Dialogues with Your Patients About Medication Nonadherence

June 2016, Vol 4, No 6 - The First Word
Donald J. Dietz, RPh, MS

In May, I attended the Pharmacy Quality Alliance (PQA) Annual Meeting and Innovation Forum in Arlington, VA. I found the meeting very informative, and was excited to see innovative programs in healthcare—especially the pharmacy initiatives. The goal of many of these initiatives is to improve the quality of healthcare, and lower overall costs.

Pharmacists and Medication Nonadherence

As we have heard for many years, medication nonadherence is a major issue where pharmacists can play a key role in improving health outcomes for patients with many diseases. Methods for engaging patients in an open discussion about their medication usage and reasons for nonadherence, however, is often a challenge. One of the PQA sessions discussed an innovative concept called the Drug Adherence Work-up (DRAW) tool, which was developed at the University of Iowa and copyrighted at the beginning of this decade. The DRAW tool is a 2-page form consisting 11 questions designed to foster pharmacist−patient conversations about the patient’s medication usage.1 If the patient affirms they have an issue with their medication usage, the DRAW tool provides suggested actions and activities that may help resolve the medication issue and improve adherence.

It is widely known that medication adherence is a complex issue, often with multiple and varied reasons for nonadherence. The questions contained in the DRAW tool are broad and cover multiple areas, including concerns regarding cost, side effects, and forgetfulness.2 Depending on patients’ responses to specific questions, suggested strategies to combat nonadherence include reminder tools and alarms, simplified dosage regimens, changes to lower-costing therapeutic alternatives, tablet splitting, and patient education.

Impact of the DRAW Tool

During the Outcomes MTM (medication therapy management) PQA presentation that detailed the DRAW tool, researchers described how a health plan client engaged with and implored them to improve medication adherence. Outcomes MTM explained how the DRAW tool has provided pharmacists with a structured dialogue to help “tease out” barriers to medication adherence. One unique issue uncovered through the use of DRAW was transportation, because a patient had difficulty obtaining a ride to the pharmacy to obtain medication refills. The pharmacy helped resolve the issue by delivering medication refills to the patient, leading to improved medication usage for that patient.

Follow-up is the last step in the DRAW tool. If any nonadherence issues exist, follow-up is important for evaluating whether an implemented solution helped improve medication adherence, or if other issues remain that are preventing the patient from being adherent with their medication regimen. In working with the health plan in the case study provided, Outcomes MTM suggested at least a quarterly check-in with patients to confirm medication usage and review any medication issues.


Prior to attending the 2016 PQA Annual Meeting and Innovation Forum, I was unaware of the DRAW tool and its value in supporting medication adherence. Congratulations to the team at University of Iowa for creating a simple, efficient, and usable screening aid for identifying nonadherence issues. I find conferences such as the PQA Annual Meeting and Innovation Forum invaluable whenever organizations share their success stores for others to consider, implement, and even improve upon.

Please check out the DRAW tool when you have a few minutes. Perhaps you will find it useful for use in your pharmacy practice or during MTM sessions, or even for use with a friend or relative experiencing medication adherence issues.


  1. Doucette WR, Farris KB, Youland KM, et al. Development of the Drug Adherence Work-up (DRAW) tool. J Am Pharm Assoc (2003). 2012;52:e199-e204.
  2. Million Hearts. Pharmacist drug adherence work-up tool. http://millionhearts.hhs.gov/docs/tupd/draw_tool.pdf. Accessed June 23, 2016.
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Last modified: July 26, 2016
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