16 ab1t0022

16 ab1t0022

• 1.
  Medication adherence
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  MEDICATION ADHERENCE DEFINITION: It isdefined as the exact or extent to which a patient medication taking behaviour concedes with the intention of the health advice he/she has been given.
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   Medication adherenceis the one of the most important factors that determines the therapeutic out comes, especially in a patient suffering from chronic illness/diseases.  Whatever the efficiency of the drug, it can’t act unless the patient takes it. Low medication adherence has consumed importance as it seriously undermines the benefits of current medical care and imposes a significant financial burden on individual patient and health care system as a whole.  The word ‘compliance’ can imply an authoritarian attitude on the part of health care professionals and may suggest yielding and submission by the patient.  ‘Non-compliance’ is failure or refusal to comply with advice and can imply disobedience on the part of patient.
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   Adherence totreat/treatment is the key link between treatment and outcome in medical care.  Many variables which may influence adherence have been studied, but none of them have been shown to consistently predict adherence.  Research into medication adherence has been piecemeal, and as there is no gold standard for measuring adherence, it is difficult to draw conclusions from the studies which have been done.  Further research is needed in this complex field, especially taking into account the various factors that can be controlled to improve adherence.  Medication adherence richly deserves attention and much impetus is needed to develop new ideas and theories to improve it.
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  ROLE OF PHARMACISTIN EDICATION ADHERENCE: •Pharmacists are in unique position to improve medication adherence because they can actually show the medication to the patient and relate any information to the medication itself. •Pharmacists often provide verbal education and written individualized information for the patient although the benefits of these strategies alone are unclear. • A few studies provide evidence of level ‖ or improved patient medication adherence as a result of patient education given by pharmacy. •Macdonald studied the effects of patient education by pharmacists on medication adherence in post-discharge patients, which demonstrated a clear benefit in the patients receiving education from pharmacists.
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  • In anunpublished study by authors, clear benefit was demonstrated in a randomized control trial in both asthma and COPD patients with a follow-up period of two months in improving medication adherence along with the inhalation technique following pharmacist- based educational interventional program. • It was interesting to note that the improvement in the inhalation technique continued with each educational sitting. •The patients received both oral education and written instructions in the local language about their diseases, need for regular medication and the importance of each medication in an educational programme lasting 45 minutes in each sitting.
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  The information thatpatients need to know which pharmacists can impart includes: •Name and purpose of the drug. •When and how to take the medication. •Possible side effects. •Precautions. •Interaction with food or other drugs. •Duration of therapy. •Action to take if a dose is missed. •How to tell if the medication is working or not working. Strategies to improve the patient-pharmacist relationship are in table.
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  • Apart frompatient education, a pharmacist may contribute towards improving medication adherence by other means including advice to prescribers on the simplification of drug regimens, providing patients with medication cards or medication aids such as a dosette, and by identifying the predisposing, enabling, and reinforcing factors which may contribute towards medication non-adherence. •In hospitals, clinical pharmacists have many opportunities to assess factors which may assist the patient’s medication adherence. •Though patient interviews, the pharmacists can assess the patient’s knowledge of their drug therapy and usual medication habits. •For example, does the patient have a set of routine and is family support available to supervise medication use? •The pharmacist is also able to identify if the patient has any specific problems with medication, such as a problem swallowing large tablets, or difficulty opening child-proof containers.
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  • The pharmacistscan also assess the patient’s ability to comprehend and recall information, and if an adverse drug reaction may discourage medication adherence. Strategies to improve the pharmacist-patient relationship: •Be friendly and approachable to the patient. •Improve communication skills. •Take into account the spiritual and psychological needs of the patient. •Improving patient education. •Encourage the patient to discuss there main concern without interruption (or) pre mature closing. •Elicit the patient perception of the illness and associated feelings and expectations. •Learning methods of active listening and empathy. •Give clear explanation.
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  •Check the patientunderstanding. •Simplify the therapeutic regimes. •Monitor the side effects. •Monitor the beneficial effects. •Speak the same language of patient. •Involvement of patient treatment discussion. •Through the patient interviews the pharmacist can assist the patient knowledge of their drug therapy and usual medication habits. Example: Dose of patient has a set routine and his family support available to supervise the medication use. The pharmacist has any specific problem with the medication such as swallowing of a large tablets, difficulty of opening child proof containers.
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  At the endof process the pharmacist should be able to determine the patient’s own assessment of their adherence to medication and make a professional assessment of the ways in which this can be improved. For example, this may involve counseling for any specific problems with medication and preparation of individualized medication information sheets.
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  REFERENCE: A text bookof clinical pharmacy practice – 2nd edition. Parthasarathi ; NY fort-hansen ; Nahata.