adherence Flashcards
adherence
is the extent to which an individual takes medications that correspond to the agreed recommendation from the healthcare provider (WHO)
compliance
the degree or extent of conformity to the recommendations about day-to-day treatment by the provider with respect to the timing, dosage, and frequency.
compliance measures whether a patient is physically taking their medications as prescribed,
studies show BETTER outcomes with medication adherence
TRUE
nonadherence accounts for roughly —- preventable death and —- billion in preventable medical costs annually
100k,$100
COMPARED to non-adherent patients adherent have
- lower healthcare costs (few hospitalization and ED visits)
- reduced costs of acute and outpatient care
-better health outcomes and QOL
requirements for adherence
3 requirements:
- sufficient UNDERSTANDING of the disease and the medication being used to treat it
- MOTIVATION to take the medication
- Implementation of the necessary BEHAVIOR CHANGE
the impact of adherences to meds for the requirements different between a acute and chronic conditions
Acute condition
patient understanding plays a major role
most patients with acute distress have symptoms.
it is easy to be motivated to take meds that will end the symptoms
behavioral changes are short lived and last for a few days
chronic conditions
motivation and behavioral changes are the major forces in determining adherence
life long behavioral changes. (diet, exercise, meds)
to be motivated a patient must:
-accept that something is wrong with them
- want to prevent future problems using meds
- believe that pros of meds > cons
patient understanding is the foundation for adherence BUT LESS IMPACT ON the subsequent adherence
intentional non-adherence
lack of perceived efficacy
perceived adverse effects
do not care to take meds
altering the dose schedule for convenience
stop to see if it is still needed
unintentional non-adherence
-forgetfulness
-confusion
-trouble swallowing
-trouble with the device
-lack of understanding efficacy
-trouble reading labels
-lack of routine
measuring adherence
there is no agreement among clinical practitioners and researchers on the best method for assessing adherence
multiple methods should be used
each method has potential advantages and disadvantages
Objective methods
1.analyzing refill record
- eyeball method
-medication
possession ratio
- bringing all pill bottles/ organizers to appointments
- control of disease
- serum levels
5 adherence aids
objective method- refill record
can be used to measure the PERSISTENCE- approximation actual adherence rates
LIMITATIONS:
-patients may use more than one pharmacy to fill meds
- pharmacists operating outside of the healthcare delivery system do not have access to patient refill records (such as Veteran admin. )
objective methods refill record
- eyeball method : looking at ONE prescription and tracking it longitudinally to ensure patient are filling approximately EVERY 30 days.
- medication possession ratio (MPR): A ratio can be calculated to analyze adherence. generally TOO TIME consuming to be practical
MPR= # of days supply of meds filled during time period/ time period (days)
objective methods refill record
Bringing all pill bottles/ organizers to appointment
Limitations: can be time-consuming, impractical
Control of disease
Limitations:
Not always accurate
Patients can mask nonadherence by taking medications in the week(s) leading up to their appointment
objective methods refill record
Serum levels
Can be used for drugs with readily available therapeutic serum level determinations
Limitations: expensive, time-consuming, not always available, may be affected by individual characteristics (genetic polymorphisms, variations in absorption, excretion, etc)
Adherence aids
Using technology to measure adherence (such as computerized prescription lids)
Limitations: can be outsmarted
Subjective methods
Patient interviews during routine visits
Providers must engage with patients to uncover the following information:
How is the medication working?
What problems do you think it may be causing?
What problems are you having in remembering to take your medications?
Requires strong provider communication technique to ensure patient does not feel judged
Limitations
Experts cite lack of accuracy- concern that patients may lie about medication adherence
Sample conversations
Introduce your perspective on medication:
*“Together, we want to find a medicine that you are genuinely interested in taking because it controls your disease without side effects. You are the one who is putting the medication into your body, so it’s your opinion that is most important, not mine. So please always let me know exactly what you think about the medicines we are trying. I’m counting on your input. In addition, most people have problems figuring out how to fit taking medication and other changes into their existing life.”
Tell patients you will ask about each issue at each visit
*“Therefore, because I need your honest input to make this medicine work best for you, at each visit I’m going to ask you how it’s working, what kind of problems you think the medication might be causing, plus ask about problems you may be having in remembering to take your medicines. We can then work together to resolve any issues that may arise.”
“Since your last visit, what kind of problems have you been having remembering to take your medications?”
WHO
According to the World Health Organization (WHO), in developed countries, only 50% of patients with chronic diseases (such as HTN, DM) adhere to treatment recommendations.
Barriers to adherence
Healthcare professionals should have a heightened awareness of barriers to adherence and predictors of nonadherence so they can effectively target successful interventions
Barriers may be multifactorial
Patient related
Disease related
Treatment related
Provider related
System related
Strategies to improve adherence
Nonadherence is multidimensional- no single strategy is effective across all conditions and settings
Interventions must account for barriers to medication adherence and address multiple factors
Medication nonadherence does not only involve patient and provider issues but also systemic problems
Strategies to improve adherence
Patient education about medications and disease states:
-Helpful to improve health literacy, decrease concerns about medication side effects, motivate patients about self-care, and increase awareness of the harmful effects of asymptomatic diseases
Improved communication between healthcare professional and patients:
Increasing accessibility to care via more clinic hours or more frequent appointments:
Improving dosing schedules:
-Simplifying medication regimens from multiple times a day to once daily or transdermal applications
-Simplifying dosing frequencies has been correlated with increased adherence rates
Adherence techniques
Develop a routine
Simplify the treatment regimen
Reducing number of medications taken and frequency of dosing
Look for combinations products to reduce number of pills taken daily
Minimize medications taken > twice daily
Minimize cost
Tailor the regimen
Adapt to the individual patient’s routine, schedule, etc.
Confirm appropriate administration technique
Reward patient success
Enlist support of others
Use adherence aids
Motivational interviewing
Motivational interviewing
A technique that enhances individuals’ motivation to change their behaviors by means of four principles
Interviewers help patients link medication use to the task that patients deem the most important, motivating patients to achieve the goal they set through improved adherence to medications
Denoted by the acronym “RULE”
Resist the righting reflex
Understand the patient’s motivations
Listen with empathy
Empower the patient
links med use to achieving goals
Teach back method
Should be employed at the end of every patient encounter to ensure adequate understanding of the information
One study estimates that patients do not remember or misinterpret 50% of information given by providers
Use open-ended questions to discuss information
“Tell me in your own words how to take this medication”
Avoid quizzing the patient, using medical jargon or highly technical terms, appearing rushed or annoyed, and simple yes/no questions
