Adherence-Kohlenberg

Question 1

WHy is adherence an important subject? What % of patients struggle with adherence to meds?

Answer 1

Approximately 50% of patients do not take medications as prescribed
Medication adherence is not exclusively the responsibility of the patient
Increasing adherence may have a greater effect on health than improvements in specific medical therapy

Question 2

What is primary adherence?

Answer 2

filling the prescription

Question 3

What is rational non adherence?

Answer 3

it is more worth it to me to take my bus ticket to pick up my child from school than to get my med from the pharmacy
it is more worth it to me to spend that money on milk than the med

Question 4

How do HTN meds affect the incidence of stroke & MI?

Answer 4

Stroke: reduce the risk for this by 30%
MI: reduce the risk for this by 15%

Question 5

2 years out, how many patients discontinued their statins?

Answer 5

75% reduction in number patients taking it.

Question 6

What is the concept of compliance?

Answer 6

Implies that the patient passively follows the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between patient and physician.

Question 7

WHat are some patient centered factors that cause poor medication adherence?

Answer 7

Lack of understanding, lack of involvement, poor medical literacy.
Health beliefs
Costs, transportation, support (a big problem with mood disorders and CVD)

Question 8

What is the greatest risk factor for heart failure in the elderly?

Answer 8

medication nonadherence

Question 9

What are some health system factors that contribute to poor adherence?

Answer 9

Costs, lack of time, fragmented systems, poor coordination.

Question 10

T/F Men are less adherent to HTN medications.

Answer 10

False. Women are less adherent!

Question 11

What are some health system factors that can increase adherence?

Answer 11

Team based approaches, including non-physician staff to help. Phone reminders.
Starting long term medications during a hospitalization for an acute event, rather than after d/c, may improve adherence.
Medication reconciliation: a list of all medications, including name, dose, frequency, route, and comparing it with transfer/discharge orders.

Question 12

T/F Physicians can always spot a non-adherent patient.

Answer 12

False. Esp w/ high functioning patients.

Question 13

T/F Patients recall as little as 50% of what is said.

Answer 13

True.

Question 14

T/F Compliance decreases the more doses are required per day.

Answer 14

True.

Question 15

Which was a more effective intervention:
patient education
positive affect + patient education

Answer 15

Positive affect + patient education

Question 16

What is the prevalence like for sudden cardiac death in women?

Answer 16

makes up 50% of cardiac deaths in women

sometimes women without any previous presentation of heart disease