Adherence - Dr.Horan Flashcards
Adherence
The extent to which an individual takes medications corresponding to the agreed recommendations from a healthcare provider. (Definition from the World Health Organization)
Compliance
The term “compliance” used to refer to the extent to which a patient followed medical advice or treatment as prescribed by a healthcare professional. However, this term has been replaced by “adherence,” which focuses on the collaborative agreement between the patient and healthcare provider rather than implying a one-sided obligation.
Consequences of Nonadherence
studies show that patients have better outcomes with medication adherence.
Adherence Benefits
: Adherent patients experience lower healthcare costs, including fewer hospitalizations and ED visits.
Cost Reduction of adherence
Medication adherence is associated with reduced costs of acute and outpatient care.
Health Outcomes of adherence
: Adherent patients generally enjoy better health outcomes and an improved quality of life.
Nonadherence Impact: deaths
Nonadherence contributes to roughly 100,000 preventable deaths annually.
Economic Impact of adherance
Nonadherence results in approximately $100 billion in preventable medical costs each year.
Requirements for Adherence
Sufficient understanding of the disease and medications used for treatment.
Motivation to take the medication.
Implementation of necessary behavior change.
Understanding and Medications
Adequate understanding of the disease and medications is crucial for adherence.
Motivation to Take Medication
Having the motivation to adhere to medication schedules significantly impacts adherence rates.
Behavior Change Implementation
Implementing necessary behavior changes is essential for maintaining adherence.
Impact on Acute Conditions
Patient understanding is crucial in managing acute conditions and their medications.
Motivation in Acute Conditions
Patients in acute distress are often highly motivated to take medications due to immediate symptom relief.
Behavioral Changes in Acute Conditions
Behavioral changes in acute conditions tend to be short-lived, often lasting only a few days.
Patients do not have to commit to a therapy for a long time
Key Factors in Acute Adherence
Understanding, motivation, and short-lived behavioral changes are pivotal for adherence in acute conditions.
Chronic Conditions and Adherence
Motivation and behavioral changes are key determinants of adherence in chronic conditions.
Lifelong Behavioral Changes
Chronic conditions often require lifelong behavioral changes such as diet, exercise, and consistent medication use.
Motivational Factors of a Chronic Condition
Patients must accept their condition, aim to prevent future issues with medication, and perceive the benefits of medication as outweighing the drawbacks to stay motivated.
Impact of Understanding- chronic
Patient understanding is foundational for adherence in chronic conditions but has less impact on subsequent adherence compared to motivation and behavioral changes.
Key Forces in Chronic Adherence
Motivation, behavior, and foundational understanding are crucial forces shaping adherence in chronic conditions.
Intentional Non adherence
Intentional nonadherence factors include lack of perceived efficacy, perceived adverse effects, not caring to take medicine, altering dose schedule for convenience, and stopping to see if still needed.
Unintentional Nonadherence
Unintentional nonadherence involves factors like forgetfulness, confusion, trouble swallowing, trouble with device usage, lack of understanding efficacy, trouble reading labels, and lacking a routine.
Measuring Adherence- how?
Lack of consensus among practitioners and researchers on the best method for assessing adherence exists.
Why is there Use of Multiple Methods?
It’s recommended to employ multiple methods for assessing adherence
Method Advantages and Disadvantages
: Each method utilized for measuring adherence carries its own potential advantages and disadvantages.
Objective methods
Analyzing how often they get refills, visually examining the number of pills left in a prescription bottle, etc.
Medication Possession Ratio (MPR)
Objective:
MPR calculates adherence based on the ratio of days’ supply of medication obtained versus days needed.
Bringing Pill Bottles/Organizers
: Patients bringing all pill bottles or organizers to appointments is a tangible method to assess adherence.
Disease Control Assessment
: Disease control can sometimes serve as an indirect measure of adherence to medication regimens.
Serum Levels
Analyzing serum levels of medication can directly assess adherence.
Adherence Aids
Various aids, such as pill organizers or reminder apps, are used to assist in monitoring and enhancing adherence.
Refill Record for Adherence
Refill records can measure persistence, offering an approximation of actual adherence rates.
It helps gauge how consistently patients obtain refills over time.
Limitations of using Refill Records
Limitations include patients using multiple pharmacies and pharmacists operating outside healthcare systems without access to patient refill records (e.g., Veterans Administration).
: Eyeball Method
This involves tracking one prescription longitudinally, ensuring patients fill approximately every 30 days to assess adherence
Medication Possession Ratio (MPR)
MPR is a ratio used to analyze adherence, calculated by dividing the number of days’ supply of medications filled during a time period by the time period (days).
MPR Calculation
: MPR = Number of days supply of medications filled during time period ÷ Time period (days).
Patient BD is on
atorvastatin 20mg tablets-
he has received 150 tablets
over a 180 day period.
Calculate the MPR.
MPR = 0.83
150/180
Bringing Pill Bottles/Organizers
Patients bringing all pill bottles or organizers to appointments is an objective method to assess adherence.
Limitations of Bringing Pill Bottles/Organizers
It can be time-consuming and impractical as a method to assess adherence.
Disease Control Assessment
Disease control is sometimes used as an objective measure of adherence.
How well theyre handling their disease
Limitations of Disease Control Assessment
: It’s not always accurate, as patients may intentionally take medications leading up to appointments to mask nonadherence.
Serum Levels for Adherence
Serum levels can be utilized for drugs with readily available therapeutic serum level determinations as an objective method to assess adherence.
Limitations of Serum Levels
limitations include expense, time consumption, availability, and susceptibility to individual characteristics that can influence accuracy
Adherence Aids
: Adherence aids, like technology-based measurements (e.g., computerized prescription lids), are used to objectively measure adherence.
Limitations of Adherence Aids
These aids may have limitations as individuals can find ways to circumvent or outsmart the technology, affecting accuracy.
Patient Interviews during Visits
Subjective.
Patient interviews during routine visits involve engaging with patients to gather information on medication efficacy, perceived problems, and adherence challenges.
Information Uncovered during patient interviews
Providers aim to uncover details like medication effectiveness, potential side effects, and challenges in remembering to take medications.
: Provider-Patient Communication
: Effective provider communication is crucial to ensure patients feel comfortable and not judged during these discussions.
Limitations of Interviews
Lack of accuracy is a concern as patients might not always provide truthful information about their medication adherence due to various reasons, including fear of judgment or desire to please the provider.
Stats about medication adherence
in developed countries, the World Health Organization (WHO) reports that only 50% of patients with chronic diseases like hypertension (HTN) and diabetes mellitus (DM) adhere to treatment recommendations.
Healthcare Professional Awareness of adherence
HCPs need to be aware of barriers to adherence and predictors of nonadherence for effective intervention strategies.
Multifactorial Nature of Barriers
: Barriers to adherence can be multifactorial, stemming from patient, disease, treatment, provider, and system-related factors.
Patient-Related Barriers
Barriers originating from patients themselves can significantly impact adherence to treatment.
Disease-Related Barriers
Characteristics of the disease or its progression can pose barriers to adherence.
ex: patient has Alzheimer’s and forgets
Treatment-Related Barriers
Aspects related to the treatment regimen or its side effects can become barriers to adherence.
Provider-Related Barriers
factors related to healthcare providers, such as communication or access to providers, can impact patient adherence.
System-Related Barriers
Issues within the healthcare system itself, like access to care or structural challenges, can hinder patient adherence.
Multidimensional Nature of Nonadherence
Nonadherence is multidimensional, and no single strategy works universally across all conditions and settings.
Addressing Barriers
Interventions need to consider barriers to medication adherence and tackle multiple factors contributing to nonadherence.
Comprehensive Approach
Improving medication adherence requires addressing not only patient and provider issues but also systemic problems within healthcare settings.
Patient Education
: Educating patients about medications and disease states can improve health literacy, decrease concerns about side effects, motivate self-care, and raise awareness of asymptomatic diseases’ harmful effects.
Enhanced Communication
Improved communication between healthcare professionals and patients is crucial for better adherence.
: Increased Accessibility to Care
: Increasing accessibility through extended clinic hours or more frequent appointments can aid in better adherence.
Optimizing Dosing Schedules
Improving dosing schedules, such as simplifying regimens to once-daily or transdermal applications, can enhance adherence rates.
Simplified Regimens
Simplifying dosing frequencies has been linked to increased adherence rates, especially when reducing from multiple times a day to once daily.
Routine Development
Developing a routine aids in adherence to treatment regimens.
Simplification of Regimen
Simplifying treatment regimens by reducing medication count and dosing frequency enhances adherence.
Combination Products
Using combination products reduces the number of pills taken daily, aiding adherence.
Minimizing Dosing Frequency
: Reducing medications taken more than twice daily supports adherence.
Cost Minimization
Minimizing medication costs can facilitate better adherence.
Tailoring the Regimen
Adapting treatment plans to fit an individual’s routine, schedule, etc., improves adherence.
Confirm Administration Technique
Ensuring the correct administration technique is crucial for adherence.
: Rewarding Success
Recognizing and rewarding patient adherence success can reinforce positive behaviors.
Enlisting Support
Involving and gaining support from others, such as family or caregivers, aids in adherence.
Adherence Aids
Utilizing adherence aids, such as pill organizers or reminder apps, helps in maintaining adherence.
Motivational Interviewing
Using motivational interviewing techniques can effectively enhance patient motivation and adherence.
Motivational Interviewing Technique
Motivational interviewing enhances motivation for behavior change through four principles denoted by “RULE.”
R: RULE
Resist the Righting Reflex
Interviewers avoid the urge to immediately correct or instruct patients but instead focus on understanding their perspectives.
U: RULE
UNDERSTAND THE PATIENT’S MOTIVATION;
The technique involves understanding the motivations driving the patient’s behavior and adherence.
L: RULE
Listen with Empathy
Practitioners actively listen and show empathy towards the patient’s experiences, fostering a supportive environment.
E: RULE
Empower the Patient
Empowering patients by encouraging their autonomy and involvement in setting goals enhances their commitment to achieving improved adherence.
Teach-back Method
Employed at the end of every patient encounter to ensure understanding of provided information.
Information Recall Study
Studies estimate that patients might not recall or misinterpret 50% of the information provided by healthcare providers.
Open-ended Questions
Using open-ended questions like “Tell me in your own words how to take this medication” helps in assessing patient understanding.
Effective Communication
To enhance understanding, avoid quizzing, medical jargon, rushing, or using simple yes/no questions. Encourage patients to express information in their own words.
