3.3. The Reality of Non-Compliance
- 1. The Reality of Non-ComplianceGreenPharmEdu.org
- 2. Non-compliance or Non-adherenceNon-complianceoccurs when a patient fails to take medication as directed.Also called Non-adherence or ConcordanceThere are many forms and subtleties, often these terms are used interchangeably.
- 3. Non-CompliancePurposeful deviation from prescribed directionsCan be conscious or unconsciousUnder-adherence or over-adherenceMajor cause of wasted drugsVarious sources site occurrence about 50%
- 4. National Council on Patient Information and EducationHalf polled said they had forgotten to take a prescribed medicineOne third prematurely ceased treatmentOne quarter used less than recommended doseOne third failed to fill prescriptions Enhancing Prescription Medicine Adherence: A National Action Plan http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf
- 5. Sorensen et al (2005) Medication management at home: medication risk factor prevalence and inter-relationships “The number of medications present in a home serves to reflect poor healthcare outcomes more reliably then the number of medications a patient is aware of taking.”Poor storage strategies and accumulated medications are strongly correlated with adverse healthcare outcomes. Sorensen, L. Stokes, LA, Purdie DM, Woodward M, Roberts MS, 2005, Medication management at home: medication risk factor prevalence and inter-relationships Journal of Clinical Pharmacy and Therapeutics Volume 31, Issue 5, pages 485–491, October 2006
- 6. Four common manifestationsForgot to take medications as directedFailed to fill a prescriptionTaking less then recommended dose or early discontinuationSubstituting OTC in place of filling a prescription
- 7. Pound et al“We argue that peoples’ resistance to medicine taking needs to be recognized and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicinesPound, P Britten, Morgan, M Yardley, L, Pope, C, Daker-White, Campbell, R (2005) Resisting medicines: a synthesis of qualitative studies of medicine taking. Social Science and Medicine, 2005 61(1): 133-155https://files.pbworks.com/download/Peykf61J6W/europharm/19341793/Pound_2005%5B1%5D.pdf
- 8. Resisting Medications“Widespread caution about taking medicines highlighted the lay practice of testing medicines, mainly for adverse effects.”“The main reason why people do not take their medicines as prescribed is not because of failings in patients, doctors or systems. “On the whole, the findings point to considerable reluctance to take medicine and a preference to take as little as possible.”Pound, P Britten, Morgan, M Yardley, L, Pope, C, Daker-White, Campbell, R (2005) Resisting medicines: a synthesis of qualitative studies of medicine taking. Social Science and Medicine, 2005 61(1): 133-155https://files.pbworks.com/download/Peykf61J6W/europharm/19341793/Pound_2005%5B1%5D.pdf
- 9. Medicines non-use in primary careDislike by patient for using drugsFear of becoming addicted to non-addictive drugsFear of long-term adverse effectsDistrust of physiciansBelief that prescription is unnecessaryBelief that that taking a medication confirms the illnessMackridge AJ, Medicines Non-Use in Primary Care. 2007; Aston University, Birmingham http://mackridge.com/wp-content/uploads/2008/12/complete-thesis-web.pdf
- 10. CostsPrescriptions costs are too highDesire to conserve medications for future use by hording, skipping doses or splitting doesCosts high enough that consumers continue to hand on to medications beyond actual utility.Kennedy, J,& Christopher Erb, C (2002) Prescription Noncompliance due to Cost Among Adults With Disabilities in the United States, American Journal of Public Health | July 2002, Vol 92, No. 7http://ajph.aphapublications.org/cgi/reprint/92/7/1120.pdf
- 11. Cover upSome patients continue to reorder medications in order to hide this lack of compliance!Auto-refills and mail order pharmacies make this worse!Braund, R.; Peake, B. M.; Shieffelbien, L.Disposal practices for unused medications in New Zealand, Environment International2009 Vol. 35 No. 6 pp. 952-955
- 12. Consequences of Poly-pharmacyAs number of medications increases, so do non-compliance rates!One in four seniors take between 10 and 19 pills daily!Any number over three prescriptions is associated with greater non-compliance!Van Dusen, A (2009) Are you taking too many medications? Forbes.com, July 19http://www.forbes.com/2008/06/19/health-drugs-prescriptions-forbeslife-cx_avd_0619health.html
- 13. Brown-bag Medication ReviewMore effective drug usage is effected by awarenessfor both physician and patient.Linkages between drug life-cycle is key to reducing a variety of issues. Ask patients to bring in all their medications for a review-prescriptions and OTCCan reveal medications from other physciansAllows for dosage adjustingBuilds collaborative ‘shared-decision making”
- 14. Asynchronous prescribingPatients with on several prescriptions have refill cycles out of sync.This can lead to over prescription or under-utilizationCoventry Teaching PCT 2007http://reports.pmetbtrainingsurveys.org/IndicatorScores.aspx?agg=AGG01|2007&groupcluster=5MD
- 15. Prescriber and Rational PrescribingPrescribers role have an impact.Are medications necessary? Are they over-prescribed?Physicians respond to the expectations of the patientOffers a clear conclusion to the consultation
- 16. Most significant is the knowledge of prescriberPhysicians prescribe more then patients expect!When patients expected prescriptions, they were three times more likely to gain prescriptions for new conditionsWhen physicians assume that the patient was expecting a prescription, the patient was 10 times more likely to be issued a prescription!Cockburn, J & Pit, S (1997)Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations—a questionnaire study. BMJ 1997; 315 : 520http://www.bmj.com/content/315/7107/520.full