Adherence Flashcards

1
Q

Define adherence

A

The extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider

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2
Q

Medication Possession Ratio (MPR)

A

MPR = Days supplied from refills /days observed

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3
Q

High Adherence Definition

A
  • Taking greater than or equal to 80% of prescribed medications
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4
Q

Other ways to measure adherence

A

Direct observation

Blood levels of the drug

Pill counts

Patient self-report

Questionnaires / scores

Electronic monitoring

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5
Q

Morisky Scale

A

1) Have you ever forgotten to take your BP medicine?
(2) Are you sometimes careless in your regards to your medicine?
(3) Do you skip your medicine when you are feeling well?
(4) “When you feel badly due to the medicine, do you skip it?”

1 point for each “YES”
Higher scores increase risk for non-adherence

Accuracy uncertain

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6
Q

Medication Event Monitoring System

A
  • Just one V at the top, missed a dose
  • A large black line at top, missed multiple doses
    Lots of info, but not used
  • Expensive
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7
Q

What medications have poor adherence?

A
  • Chronic medications
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8
Q

Non-persistence Adherence

A

Discontinuation of a medication

Likely the most common cause of low adherence

Non-persistence often occurs within the first few months of starting a drug

not seeing benefit immediately

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9
Q

Poor Execution

A

Failing to follow dosing instructions

  • failing to take enough!

TECHNICALLY – “over-dosing” is an example of non-adherence due to poor execution.
However, non-adherence is not typically used to describe this situation

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10
Q

Primary Non-adherence

A

Patients never take their prescription to the pharmacy

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11
Q

Why is distinguishing poor adherence important?

A

Poor adherence may eliminate the benefit of the drug

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12
Q

Consequences of non-adherence

A

2/3 of all drug-related hospitalizations may be preventable

20% to 30% of life-threatening events may be preventable

Cost of preventable events in Canada estimated at $10 billion per yr

Medication errors?
Over prescribing from perceived ineffectiveness
Duplicate prescribing from transitions of care

Waste of taxpayers money
Reimbursement for drugs that will never take effect

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13
Q

Investing in Drug Costs

A

Almost 30% of all health care costs in Canada originate from hospitals

Therefore, optimizing the management of chronic diseases in the community setting can help decrease health care costs (if we can prevent expensive hospitalizations like heart attacks etc)

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14
Q

Six categories proposed to organize factors causing non-adherence

A

Patient Factors –> Knowledge, attitudes, beliefs, literacy, education

Drug Factors –> Side effects, cost, benefits

Disease Factors –> Symptoms, prognosis

System Factors –> Specialist avilability, testing, distance from clinics, organization of care, racism

Socioeconomic factors –> acess, transportation, income, competing priorities in the family

Provider factors –> Communication, Knowledge, trust

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15
Q

Interpretation Warnings

A

Poor knowledge, low incomes can be reasons for poor adherence

Poor adherence does not equal poor attitude

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16
Q

Chronic Conditions RX Drugs Perceptions by PT

A

are often costly to patients

..are often perceived as risky by patients

… may be deemed unnecessary by patients

WE NEED TO REMEMBER THAT DRUGS are NOT a guarantee for health

17
Q

Why may people be nervous about medications?

A

News reports

Feeling of “unnatural” chemicals in the body

Long term diseases such as cancer when drugs taken for yrs

Concern over number of drugs taken together

YOU MUST HAVE AN INFORMED OPINION ON ALL OF THESE CONCERNS (AND MORE)

18
Q

Simple Framework For Adherence

A

Necessity vs. Risk

if pt sees risk as higher than necessity, may become non-adherent

19
Q

Cautions for Pharmacist

A

Don’t make adherence THE problem

Don’t assume all adherence is INTENTIONAL

NEVER assume that patients are complainers or liars

ACCEPT that sometimes non adherence is the right outcome

Agree to DISAGREE