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CPP101 > adherence > Flashcards

adherence Flashcards

1
Q

adherence

A

is the extent to which an individual takes medications that correspond to the agreed recommendation from the healthcare provider (WHO)

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2
Q

compliance

A

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,

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2
Q

studies show BETTER outcomes with medication adherence

A

TRUE

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2
Q

nonadherence accounts for roughly —- preventable death and —- billion in preventable medical costs annually

A

100k,$100

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2
Q

COMPARED to non-adherent patients adherent have

A
  • lower healthcare costs (few hospitalization and ED visits)
  • reduced costs of acute and outpatient care
    -better health outcomes and QOL
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2
Q

requirements for adherence

A

3 requirements:

  1. sufficient UNDERSTANDING of the disease and the medication being used to treat it
  2. MOTIVATION to take the medication
  3. Implementation of the necessary BEHAVIOR CHANGE

the impact of adherences to meds for the requirements different between a acute and chronic conditions

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2
Q

Acute condition

A

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

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3
Q

chronic conditions

A

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

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4
Q

intentional non-adherence

A

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

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5
Q

unintentional non-adherence

A

-forgetfulness
-confusion
-trouble swallowing
-trouble with the device
-lack of understanding efficacy
-trouble reading labels
-lack of routine

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6
Q

measuring adherence

A

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

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7
Q

Objective methods

A

1.analyzing refill record
- eyeball method
-medication
possession ratio

  1. bringing all pill bottles/ organizers to appointments
  2. control of disease
  3. serum levels

5 adherence aids

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8
Q

objective method- refill record

A

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. )
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9
Q

objective methods refill record

A
  1. eyeball method : looking at ONE prescription and tracking it longitudinally to ensure patient are filling approximately EVERY 30 days.
  2. 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)

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10
Q

objective methods refill record

A

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

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11
Q

objective methods refill record

A

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

12
Q

Subjective methods

A

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

13
Q

Sample conversations

A

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?”

14
Q

WHO

A

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.

15
Q

Barriers to adherence

A

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

16
Q

Strategies to improve adherence

A

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

17
Q

Strategies to improve adherence

A

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

18
Q

Adherence techniques

A

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

19
Q

Motivational interviewing

A

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

20
Q

Teach back method

A

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

CPP101 (5 decks)

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