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Medication adherence
The document discusses medication adherence, defined by the WHO as the extent to which patients follow healthcare provider recommendations in taking medications. Non-adherence can lead to increased healthcare costs, preventable deaths, and complications, influenced by various factors such as socio-economic status, patient beliefs, and healthcare system challenges. Strategies to improve adherence include simplifying regimens, providing education, fostering communication, and utilizing various measurement approaches to monitor compliance.
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Medication adherence
- 1. - Prejith PhilipChacko - Pharm d
- 2. Adherence âą Defined bythe WHO as â the extent to which a persons behaviour {in} taking medicationsâŠ. Corresponds with agreed recommendations from a health care providerâŠ.â âą -world health organization
- 3. Medication adherence âą Theact of filling a new prescription for the first time, or refilling prescriptions on time. âą The extent to which patients take medications as prescribed by health care providers.
- 4. Benefits of MedicationAdherence âą Enhances patient safety. âą Decreases health care costs. âą Improves long-term therapies and outcomes. âą Good investment for tackling chronic conditions
- 5. compliance âą The termcompliance has come into disfavour coz it suggests that a person is passively following doctors orders, rather than actively collaborating in the treatment process. âą Adherence on the other hand, requires the persons agreement to the recommendations for therapy.
- 6. âą So thisconcludes that compliance is defined as the act of taking medications as the doctor intended âą Correct medication. âą Correct amount of medication. âą Correct time of day. âą Correct length of time.
- 7. Adherence & complianceis related to âą Knowledge & beliefs about illness. âą Motivation to get better. âą Confidence in ability to help oneself get better. âą Expectation about the outcome of treatment & results from not being adherent.
- 8. Medication non adherenceinclude:- âą Fail to fill the first prescription. âą Fail to refill the prescription as directed. âą Skipping doses. âą Stopping the medications too soon. âą Taking the doses at the wrong time. âą Taking medication with foods, drinks or other medications it shouldnât be used with. âą Taking expired medication. âą Storing medications in the wrong place. âą Using devices improperly like inhalers.
- 9. Barriers to TakingYour Medications: âą Canât always see or feel the benefits of your medications âą Side effects âą Unsure what your medication is being used for âą Busy schedule or lifestyle âą Multiple medications, with multiple doses per day âą Hard to remember âą Concerned about risks of your medications âą Donât feel like you need the medication âą Cost
- 10. What happens whenyou donât take medications as prescribed? âą Your medications wonât work as well, you wonât feel better âą Your doctor may think it isnât working and add an additional medication âą You may feel worse âą Increased healthcare spending
- 11. What happens whenyou donât take medications as prescribed? (cont.) âą Potential harm- both from too much and not enough of your medication âą The cause of 33-69% of medication related hospital admissions âą Average length of stay in a hospital, due to non- adherence is 4.2 days âą Preventable deaths due to non-adherence are estimated to be 125,000 each year
- 12. The Five DimensionsOf Non-adherence âą Defines adherence as a multidimensional phenomenon determined by the interplay of five sets of factors. âą A holistic approach to address improve medication adherence. âą These dimensions interact with one another. âą Are patients solely responsible for taking their treatments?
- 13. Socio-economic factors âą Poverty âąIlliteracy âą Unemployment âą Family dysfunction âą High cost of transport âą High cost of medication âą Low level of education âą Poor socioeconomic status âą Unstable living conditions âą Long distance from treatment centre
- 14. Condition related factors âąDisability level âą Follow-up treatment âą Emphasis on adherence âą Available effective treatments âą Progression /severity of the disease âą Co-morbidities (e.g. Depression and drug/alcohol abuse
- 15. Therapy-Related factors âą Side-effects âąTreatment duration âą Available medical support âą Complex medical regimen âą Previous treatment failures âą Immediate beneficial effects âą Frequent changes in treatment
- 16. Pt related factors âąForgetfulness âą Low motivation âą Psychosocial stress âą Disbelief in the diagnosis âą Low treatment expectations âą Low attendance at follow-up âą Lack of acceptance of monitoring âą Disease symptoms and treatment âą Hopelessness and negative feelings
- 17. Health systems factors âąShort consultations âą Poor health services âą Interventions for improving it âą Overworked health care providers âą Poor medication distribution systems âą Inadequate training for health care providers âą Lack of incentives and feedback on performance Lack of knowledge on adherence and of effective âą Weak capacity of the system to educate patients and provide follow-up âą Inability to establish community support and self-management capacity
- 18. strategies to ImproveMed. Adherence âą The SIMPLE approach âą S â Simplify the regimen âą I â Impart knowledge âą Mâ Modify patient beliefs and behavior âą P â Provide communication and trust âą L â Leave the bias âą E â Evaluate adherence
- 19. SâSimplify the Regimen âąEncourage use of adherence aids. âą Investigate customized packaging for patients âą Adjust timing, frequency, amount, and dosage âą Match regimen to patientâs activities of daily living âą Consider changing the situation vs. changing the patient âą Avoid prescribing medications with special requirements âą Recommend taking all medications at the same time of day
- 20. IâImpart Knowledge âą Adviseon how to cope with medication costs âą Focus on patient-provider shared decision making âą Involve patientâs family or caregiver if appropriate âą Keep the team informed (physicians, nurses, pharmacists) âą Provide all prescription instructions clearly in writing and verbally âą Reinforce all discussions often, especially for low-literacy patients âą Suggest additional information from Internet for interested patients
- 21. MâModify Patient Beliefsand Behavior âą Address fears and concerns âą Provide rewards for adherence âą Empower patients to self-manage their condition âą Ask patients about the consequences of not taking their medications âą Have patients restate the positive benefits of taking their medications âą Ensure that patients understand their risks if they donât take their medications
- 22. PâProvide Communication andTrust âą Use plain language âą Practice active listening âą Provide emotional support âą Improve interviewing skills âą Elicit patientâs input in treatment decisions
- 23. LâLeave the Bias âąDevelop patient-centered communication style âą Acknowledge biases in medical decision making âą Understand health literacy and how it affects outcomes âą Address dissonance of patient-provider, race-ethnicity, and language âą Examine self-efficacy regarding care of racial, ethnic, and social minority populations
- 24. EâEvaluating Adherence âą Self-report âąAsk about adherence behavior at every visit âą Periodically review patientâs medication containers, noting renewal dates âą Use biochemical testsâmeasure serum or urine medication levels as needed âą Use medication adherence scalesâ e.g. âą Morisky-8 (MMAS-8), Medication Possession Ratio (MPR), âą Proportion of Days Covered (PDC)
- 25. MEASURING ADHERENCE âą Thereare several ways to measure medication adherence. âą 1.Medication event monitoring systems (MEMS):These are the most accurate method of measuring adherence because they record the date and time the medication bottle was opened through microprocessor technology embedded in the cap.
- 26. Advantages with microprocessor: âą1. erroneous/not faith/falls., because patient may remove more than one dose âą 2.Very expensive & different devices are needed for each medication âą 3.Therefore it is an impractical way to determine adherence in clinical practice.
- 27. âą 2.Patient self-reportsis easiest method when adherence is being assessed, open-ended questions should be asked. Instead of asking, âAre you taking your medications?â the HCP should phrase the question along the lines of, âHow many times in the past week (month) have you skipped your medications?
- 28. âą Pill counts âą4.Pharmacy databases or refill rates, and âą 5.Blood levels which also are employed in research, are more feasible options for clinical practice âą 6.Moriskyâs Medication Adherence Scale (MMAS) It was designed to distinguish poorly adherent patients from those with medium to-high adherence to their antihypertensive regimen
- 29. âą MMAS consistsof questions addressing multiple reasons for non-adherence.. e.g., because regimen complexity can lead to noncompliance. The scale contains a question assessing whether the patient feels hassled (trouble/Tense) about his or her regimen
- 30. âą Since patientstend to give their HCPs positive answers to please them, the questions in Moriskyâs study were phrased to avoid this bias. âą Each question measures a specific medication taking behavior rather than adherence or compliance behavior.
- 32. What patients cando to improve your adherence: âą Make a schedule âą Put them in a place thatâs easy for you to remember âą Include in your daily routine (meal, shower, brush teeth) âą Keep a current list of your medications âą Set alarms (thereâs an app for that) âą Use re-fill reminders and auto-fill options at your pharmacy âą Choose ONE pharmacy, instead of using multiple pharmacies âą Learn more about your medications
- 33. Things you shouldknow about your medications: âą Name of medication and what itâs being used for âą How long you will be taking the medication âą How you should take the medication, including how many times a day and how often âą Should you be avoiding any foods, medications, or activities while on this medication? âą Side effects to look for and what to do if they happen âą Where to store your medications
- 34. What can yourpharmacist do to help? âą Inform you about your medications âą What your medication is used for âą What to expect from using medication âą When will it start to work âą Will you notice any changes? âą Side effects to watch out for âą Answer any of your medication questions
- 35. What can yourpharmacist do to help? âą Recommend ways to help you remember to take medications Pill box Bubble packs Apps
- 36. What can yourpharmacist do to help? âą Fit medications into your schedule âą Come up with a schedule, using your daily routines âą Consider a medication that may work for a longer period of time âą Recommend storage options for medications when traveling âą Cost âą Cost savings/ discount programs âą Look for a similar medication that may cost less âą Avoid side effects âą Prevent diseases from getting worse
- 37. What can yourpharmacist do to help? âą Medication Therapy Management (MTM) âą Appointment with your pharmacist âą Bring in all medications and over the counter products (vitamins/herbals) âą Pharmacist reviews all of your medications âą Interactions âą Side effects âą Cost savings âą Adherence and compliance âą Increase your knowledge of your medications âą Answer questions
- 38. Always remember⊠⹠Non-adherenceand non-compliance is common âą You can have an impact in your health âą The reasons people donât take medications are different for each person âą Be honest and open with your pharmacists and doctors âą Pharmacists want to help you overcome barriers to adherence and compliance
Editor's Notes
- #11Â A common example I hear from patients is them taking their medication every other day instead of every day in order to save money, but as you can see from the graph 50% adherence almost doubles medical spending.