Kohlenberg: Adherence Flashcards
Approximately what percent of patients do not take medications as prescribed?
50%
Increasing (blank) may have a greater effect on health than improvements in specific medical therapy
adherence
T/F: Medication-taking behavior is complex and involves patient, physician, and process components
True
What are some solutions to reducing nonadherence?
encourage a blame free environment opt for less frequent dosing improve patient education assess health literacy pay attention to rational nonadherence
In what types of drug regimens might you see greater rates of adherence?
single drug
lower dose
RAAS drugs
Ca++ channel blockers
In what types of drug regimens might you see the worst adherence rates?
diuretics
beta blockers
dietary changes (Na+ reduction)
What is the adherence rate for statins and antihypertensives?
less than 50%
**50-80% nonadherent
How is primary adherence measured?
by filling prescriptions
**58% do not fill initial statin Rx
The most important cause of failure to achieve BP contron
adherence to meds
**according the WHO
Within 6 months to 1 year after being prescribed statins, (blank)% of patients discontinue them.
At 2 years, (blank)% of patients discontinue them.
25-50; 75%
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.
compliance
More of a collaborative model, with health care providers having some responsibility in creating the treatment contract
Adherence
What are some patient related factors that lead to poor adherence?
lack of understanding, involvement, or poor medical literacy
health beliefs
costs, transportation, support (a big problem with mood disorders and CVD)
How does age factor in to adherence?
older pts are less adherent?
**20% over the age of 65 in Medicaid programs are adherent to antihypertensive medications.
(blank) is the greatest risk factor associated with increased incidence of HF in the elderly.
medication nonadherence
Which gender is less adherent when prescribed antihypertensives?
women are more nonadherent
What are some physician related factors that lead to nonadherence?
physicians fail to recognize it, esp in high functioning patients
overly complex drug regimens
ineffective communication
What are some health system factors that contribute to nonadherence?
costs
lack of time
fragmented systems
poor coordination
How to improve patient related factors to nonadherence?
patients only recall ~50% of what is said, so be flexible
empower the patient with MI
avoid prescribing numerous meds or behavioral changes at any one visit
determine if the patient is health literate (do they know how to take it, do they know what it’s for, etc…)
create a shame free environment (different language pamphlets, recognize mental illness, recognize economic status)
T/F: Adherence is improved when a good relationship exists between patient and doctor.
True
**There are worse adherence rates if the patient doesn’t feel that the communication b/w patient and doctor is patient centered and they have trust
How should you ask a patient about their current medication regimen?
don’t just ask what meds they are currently taking! dive deeper!
**how often do you miss taking your meds?
lots prescribed to you, which ones are you taking?
have you had to stop any for any reason?
how often do you forget to take medication X?
Ways in which you can reduce complexity for the patient
limit pharmacy visits
adhere to formulary, respect economic realities
less frequent dosing
**increases number of pills per day can decrease adherence
In what ways can the health system help improve adherence?
phone reminders start long term meds during a hospitilization, not after d/c medical reconciliation (long list of all meds with name, dose, frequency, route, etc)
In the study which tracked 4 cardioprotective meds, statins, and ACE inhibitors, after implementing reconciliation, patient education, collaborative care, and 2 types of voice reminders, what was the outcome?
this improved adherence by 7%
…but did not improve clinical targets (BP and LDL levels)
