Medication adherence Flashcards
define adherence (according to the World Health Organization)
the extent to which an individual takes medications corresponding to the agreed recommendations from a healthcare provider
define compliance
complying to a wish or command
which is a preferred word to speak about patient medication use — adherence or compliance?
adherence.
compliance sounds paternalistic
what is the consequence of nonadherence?
studies show that patients have better outcomes with medication adherence
nonadherence counts for roughly _________preventable deaths and $__________ in preventable medical costs annually
100,000 preventable deaths and $100 billion in preventable medical costs annually
compared with nonadherant patients, adherent patients have…. (what 3 better outcomes?)
-lower healthcare costs (fewer hospitalizations and ED visits)
-reduced costs of acute and outpatient care
-better health outcomes and quality of life
what are the 3 requirements for adherence
- sufficient UNDERSTANDING of the disease and the medications being used to treat it
- MOTIVATION to take the medication
- implementation of the necessary BEHAVIOR CHANGE
true or false
the 3 requirements for adherence do not differ regardless of if the condition is acute or chronic
FALSE — differs
give an example of an acute condition
cold/flu
patient_______ plays a major role in adherence with acute conditions
patient UNDERSTANDING
true or false
it is easier for patients to adhere to acute conditions than chronic. explain
TRUE
it’s hard to see results with chronic disease medication.
patients with acute diseases have symptoms — easier to be motivated to take it – they understand
behavorial changes for acute conditions are short and only last for a few days
what 3 patient factors play a role in adherence to acute disease medication?
list them in order of importance, from greatest importance to least importance
greatest importance – understanding
middle – motivation
least – behavior (only lasts a few days)
is cancer an acute or chronic condition?
can be both
is HIV a chronic or acute condition?
chronic
_________ changes are the major force in determining adherence for chronic conditions
MOTIVATION and BEHAVIORAL changes
explain what kind of behavioral changes are necessary for adherence to chronic conditions
LIFELONG behavioral changes – diet, exercise, medication
to be MOTIVATED to adhere to medication for a CHRONIC disease, patients must do what 3 things?
-accept that something is wrong with them
-want to prevent future problems by using medication
-believe that the pros of medication are greater than the cons
patient ___________ is the foundation for chronic disease adherence but has LESS IMPACT ON SUBSEQUENT ADHERENCE
understanding
there is ____ and ____ nonadherence
intentional and nonintentional
is trouble swallowing/trouble using the device intentional or nonintentional adherence?
nonintentional
is altering the medication dose schedule for convenience intentional or unintentional adherence?
intentional
is having a lack of routine intentional or unintentional nonadherence?
unintentional
is lack of PERCEIVED efficacy intentional or nonintentional adherence?
intentional
is lack of UNDERSTANING efficacy intentional or unintentional nonadherence?
unintentional
is the perceived adverse effects intentional or unintentional nonadherence?
intentional
is having trouble reading the medication label an example of intentional or unintentional adherence?
unintentional
is stopping the medication to see if you still need it intentional or unintentional adherence?
intentional
is forgetfulness and confusion an example of intentional or nonintentional adherence?
unintentional
true or false
there is an agreement among clinical practitioners and researchers on the best method for assessing adherence
FALSE
TRUE OR FALSE
when measuring adherence, multiple methods should be used, and each method has potential advantages and disadvantages
true
what are the different classes of methods for measuring adherence
objective and subjective
what are the 5 objective methods of measuring adherence
- analyzing refill record
- bringing all pill bottles/organizers to appt
- how the disease is being controlled
- serum levels
- adherence aids
refill record can be used to measure _________ (which means what)
PERSISTENCE – this is an approximation of actual adherence rates
name 2 limitations of using the refill record objective method to measure adherence
-the patient may be using more than 1 pharmacy to fill
-pharmacies that operate outside of some healthcare delivery systems do not have access to patient refill records (ex: the veterans administration)
name 2 ways of using the refill method to measure adherence
the eyeball method and MPR (medication possession ratio)
explain the eyeball method of the refill record
looking at one prescription and tracking it longitudinally to ensure the patient is filling every 30 days
explain the MPR method of refill record
medication possession ratio – ratio calculated to analyze adherence.
MPR = # of days supply of medications filled during time period/time period
what is the downside of using MPR method of assessing adherence using refill record
too time consuming to be practical
when calculating MPR, a benchmark of _____% is considered “good” persistence
80%
what is a limitation to the objective method of measuring adherence: “bring all pill bottles to appt”?
can be time consuming and impractical
the objective method of measuring adherence: “control of disease”
name 2 limitations to this method
-not always accurate
-patients can mask nonadherence by taking the medication in the week(s) leading up to the appointment
the “serum levels” objective method for measuring nonadherence can be used for what kind of drugs?
those with readily available therapeutic serum level determinations
name the limitations of the serum method of measuring nonadherence
expensive
time-consuming
not always available
may be affected by varying individual characteristics (genetic polymorphisms, variations in absorption, secretion, etc)
“adherence aids” objective method of measuring nonadherence uses _________ to measure adherence
name the limitation
uses TECHNOLOGY (such as computerized prescription lids)
limitation – can be outsmarted – pt just opens the bottle a lot right before appt
what is the subjective method of measuring nonadherence
patient interviews during routine visits
in the subjective method of measuring nonadherence (patient interviews during routine visits), providers must engage with patients to uncover which 3 pieces of information?
“how is the medication working”
“what problems do you think it is causing”
“what problems are you having in remembering to take your medication”
in the subjective method of measuring nonadherence (pt interviews during routine visits) it requires strong provider _____ techniques to ensure _______
requires strong provider COMMUNICATION techniques to ensure the patient does not feel judged
what is the limitation to the subjective method of measuring adherence (pt interviews during routine visits)
experts cite a lack of accuracy —– there is a concern that patients may lie about medication adherence
in a conversation about adherence, what should the provider tell the patient
set the stage by introducing your perspective on a medication —–be sure to tell them that their opinion is valuable and you need their input on any issues with it – you’ll be asking for any issues at each visit
at each visit: “what kind of problems have you been having remembering to take your medications”
according to WHO, in developed countries, only _____% of patients with chronic diseases adhere to treatment recommendations
50%
true or false
barriers to adherence may be multifactorial
true
barriers to adherence: (5)
patient related (understanding, motivation)
disease related
treatment related (cost, bad side effects)
provider related (bad relationship, no Q’s asked)
system related
healthcare providers should have a ________ of barriers to adherence and be ______ of nonadherence so that they can _______
healthcare providers should have a HEIGHTENED AWARENESS of barriers to adherence and be PREDICTORS of nonadherence so tthey can EFFECTIVELY TARGET SUCCESSFUL INTERVENTIONS
true or false
adherence is unidimensional.
false
true or false
adherence is multidimensional and there is no single strategy that is effective across all conditions and settings
true
true or false
medication nonadherence only has patient and provider issues
false – systemic issues exist
when an intervention is being made to prevent nonadherence, it must account for _______ and address ______
the intervention must account for BARRIERS TO MEDICATION ADHERENCE and address MULTIPLE FACTORS (not just pt – also provider, systemic, etc)
name 4 strategies to improve adherence on the healthcare provider side
-patient education about medications and disease states
-improved communication btwn professionals and pts
-increasing accessibility to care (more clinic hours or more frequent appts)
-improving dosing schedules
true or false
simplifying dosing frequencies has been correlated with increased adherence rates
true – decrease from multiple times a day to once a day or even to a transdermal application
name 4 adherence techniques (more)
-develop a routine
-simplify regimen
-minimize cost
-tailor the regimen to the patient’s schedule
true or false
when simplifying the treatment regimen, you should minimize the medications being taken >3 times daily
false – greater than twice daily
list 3 ways you can simplify the treatment regimen
reduce # medications taken and frequency of dosing
-look for combination products to reduce # pills taken daily
-minimize medications taken >twice daily
name 5 more adherence techniques
confirm the appropriate administration technique
reward pt success
-enlist the support of others
-use adherence aids
-motivational interviewing
motivational interviewing is denoted by what acronym? state what everything stands for
RULE
R – resist the righting reflex
U – understand the patient’s motivations
L – listen with empathy
E – empower the patient
MOTIVATIONAL INTERVIEWING is a technique that does what?
enhances individual’s motivation to change their behaviors by means of 4 principles
those who conduct motivational interviewing link ____ to ______, which motivates patients to achieve the goal they set through improved adherence to medications
link MEDICATION USE to the TASK THAT PATIENTS DEEM THE MOST IMPORTANT
when should the teach back method be employed? why?
at the end of EVERY PATIENT ENCOUNTER to ensure adequate understanding of the information
in emphasizing the importance of the teach back method, one study estimates that patients do not remember (or misinterpret) _____% of the information given by providers
50%
in the teach back method, what should you avoid?
quizzing the patient, using highly technical medical terms, appearing rushes, and asking yes/no questions
