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Pharmaceutical Care FINAL > Medication adherence > Flashcards

Medication adherence Flashcards

1
Q

define adherence (according to the World Health Organization)

A

the extent to which an individual takes medications corresponding to the agreed recommendations from a healthcare provider

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2
Q

define compliance

A

complying to a wish or command

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3
Q

which is a preferred word to speak about patient medication use — adherence or compliance?

A

adherence.
compliance sounds paternalistic

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4
Q

what is the consequence of nonadherence?

A

studies show that patients have better outcomes with medication adherence

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5
Q

nonadherence counts for roughly _________preventable deaths and $__________ in preventable medical costs annually

A

100,000 preventable deaths and $100 billion in preventable medical costs annually

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6
Q

compared with nonadherant patients, adherent patients have…. (what 3 better outcomes?)

A

-lower healthcare costs (fewer hospitalizations and ED visits)
-reduced costs of acute and outpatient care
-better health outcomes and quality of life

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7
Q

what are the 3 requirements for adherence

A
  1. sufficient UNDERSTANDING of the disease and the medications being used to treat it
  2. MOTIVATION to take the medication
  3. implementation of the necessary BEHAVIOR CHANGE
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8
Q

true or false

the 3 requirements for adherence do not differ regardless of if the condition is acute or chronic

A

FALSE — differs

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9
Q

give an example of an acute condition

A

cold/flu

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10
Q

patient_______ plays a major role in adherence with acute conditions

A

patient UNDERSTANDING

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11
Q

true or false

it is easier for patients to adhere to acute conditions than chronic. explain

A

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

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12
Q

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

A

greatest importance – understanding
middle – motivation
least – behavior (only lasts a few days)

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13
Q

is cancer an acute or chronic condition?

A

can be both

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14
Q

is HIV a chronic or acute condition?

A

chronic

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15
Q

_________ changes are the major force in determining adherence for chronic conditions

A

MOTIVATION and BEHAVIORAL changes

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16
Q

explain what kind of behavioral changes are necessary for adherence to chronic conditions

A

LIFELONG behavioral changes – diet, exercise, medication

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17
Q

to be MOTIVATED to adhere to medication for a CHRONIC disease, patients must do what 3 things?

A

-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

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18
Q

patient ___________ is the foundation for chronic disease adherence but has LESS IMPACT ON SUBSEQUENT ADHERENCE

A

understanding

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19
Q

there is ____ and ____ nonadherence

A

intentional and nonintentional

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20
Q

is trouble swallowing/trouble using the device intentional or nonintentional adherence?

A

nonintentional

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21
Q

is altering the medication dose schedule for convenience intentional or unintentional adherence?

A

intentional

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22
Q

is having a lack of routine intentional or unintentional nonadherence?

A

unintentional

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23
Q

is lack of PERCEIVED efficacy intentional or nonintentional adherence?

A

intentional

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24
Q

is lack of UNDERSTANING efficacy intentional or unintentional nonadherence?

A

unintentional

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25
Q

is the perceived adverse effects intentional or unintentional nonadherence?

A

intentional

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26
Q

is having trouble reading the medication label an example of intentional or unintentional adherence?

A

unintentional

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27
Q

is stopping the medication to see if you still need it intentional or unintentional adherence?

A

intentional

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28
Q

is forgetfulness and confusion an example of intentional or nonintentional adherence?

A

unintentional

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29
Q

true or false

there is an agreement among clinical practitioners and researchers on the best method for assessing adherence

A

FALSE

30
Q

TRUE OR FALSE

when measuring adherence, multiple methods should be used, and each method has potential advantages and disadvantages

A

true

31
Q

what are the different classes of methods for measuring adherence

A

objective and subjective

32
Q

what are the 5 objective methods of measuring adherence

A
  1. analyzing refill record
  2. bringing all pill bottles/organizers to appt
  3. how the disease is being controlled
  4. serum levels
  5. adherence aids
33
Q

refill record can be used to measure _________ (which means what)

A

PERSISTENCE – this is an approximation of actual adherence rates

34
Q

name 2 limitations of using the refill record objective method to measure adherence

A

-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)

35
Q

name 2 ways of using the refill method to measure adherence

A

the eyeball method and MPR (medication possession ratio)

36
Q

explain the eyeball method of the refill record

A

looking at one prescription and tracking it longitudinally to ensure the patient is filling every 30 days

37
Q

explain the MPR method of refill record

A

medication possession ratio – ratio calculated to analyze adherence.

MPR = # of days supply of medications filled during time period/time period

38
Q

what is the downside of using MPR method of assessing adherence using refill record

A

too time consuming to be practical

39
Q

when calculating MPR, a benchmark of _____% is considered “good” persistence

A

80%

40
Q

what is a limitation to the objective method of measuring adherence: “bring all pill bottles to appt”?

A

can be time consuming and impractical

41
Q

the objective method of measuring adherence: “control of disease”

name 2 limitations to this method

A

-not always accurate
-patients can mask nonadherence by taking the medication in the week(s) leading up to the appointment

42
Q

the “serum levels” objective method for measuring nonadherence can be used for what kind of drugs?

A

those with readily available therapeutic serum level determinations

43
Q

name the limitations of the serum method of measuring nonadherence

A

expensive
time-consuming
not always available
may be affected by varying individual characteristics (genetic polymorphisms, variations in absorption, secretion, etc)

44
Q

“adherence aids” objective method of measuring nonadherence uses _________ to measure adherence

name the limitation

A

uses TECHNOLOGY (such as computerized prescription lids)

limitation – can be outsmarted – pt just opens the bottle a lot right before appt

45
Q

what is the subjective method of measuring nonadherence

A

patient interviews during routine visits

46
Q

in the subjective method of measuring nonadherence (patient interviews during routine visits), providers must engage with patients to uncover which 3 pieces of information?

A

“how is the medication working”
“what problems do you think it is causing”
“what problems are you having in remembering to take your medication”

47
Q

in the subjective method of measuring nonadherence (pt interviews during routine visits) it requires strong provider _____ techniques to ensure _______

A

requires strong provider COMMUNICATION techniques to ensure the patient does not feel judged

48
Q

what is the limitation to the subjective method of measuring adherence (pt interviews during routine visits)

A

experts cite a lack of accuracy —– there is a concern that patients may lie about medication adherence

49
Q

in a conversation about adherence, what should the provider tell the patient

A

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”

50
Q

according to WHO, in developed countries, only _____% of patients with chronic diseases adhere to treatment recommendations

A

50%

51
Q

true or false

barriers to adherence may be multifactorial

A

true

52
Q

barriers to adherence: (5)

A

patient related (understanding, motivation)
disease related
treatment related (cost, bad side effects)
provider related (bad relationship, no Q’s asked)
system related

53
Q

healthcare providers should have a ________ of barriers to adherence and be ______ of nonadherence so that they can _______

A

healthcare providers should have a HEIGHTENED AWARENESS of barriers to adherence and be PREDICTORS of nonadherence so tthey can EFFECTIVELY TARGET SUCCESSFUL INTERVENTIONS

54
Q

true or false

adherence is unidimensional.

A

false

55
Q

true or false

adherence is multidimensional and there is no single strategy that is effective across all conditions and settings

A

true

56
Q

true or false

medication nonadherence only has patient and provider issues

A

false – systemic issues exist

57
Q

when an intervention is being made to prevent nonadherence, it must account for _______ and address ______

A

the intervention must account for BARRIERS TO MEDICATION ADHERENCE and address MULTIPLE FACTORS (not just pt – also provider, systemic, etc)

58
Q

name 4 strategies to improve adherence on the healthcare provider side

A

-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

59
Q

true or false

simplifying dosing frequencies has been correlated with increased adherence rates

A

true – decrease from multiple times a day to once a day or even to a transdermal application

60
Q

name 4 adherence techniques (more)

A

-develop a routine
-simplify regimen
-minimize cost
-tailor the regimen to the patient’s schedule

61
Q

true or false

when simplifying the treatment regimen, you should minimize the medications being taken >3 times daily

A

false – greater than twice daily

62
Q

list 3 ways you can simplify the treatment regimen

A

reduce # medications taken and frequency of dosing
-look for combination products to reduce # pills taken daily
-minimize medications taken >twice daily

63
Q

name 5 more adherence techniques

A

confirm the appropriate administration technique
reward pt success
-enlist the support of others
-use adherence aids
-motivational interviewing

64
Q

motivational interviewing is denoted by what acronym? state what everything stands for

A

RULE

R – resist the righting reflex
U – understand the patient’s motivations
L – listen with empathy
E – empower the patient

65
Q

MOTIVATIONAL INTERVIEWING is a technique that does what?

A

enhances individual’s motivation to change their behaviors by means of 4 principles

66
Q

those who conduct motivational interviewing link ____ to ______, which motivates patients to achieve the goal they set through improved adherence to medications

A

link MEDICATION USE to the TASK THAT PATIENTS DEEM THE MOST IMPORTANT

67
Q

when should the teach back method be employed? why?

A

at the end of EVERY PATIENT ENCOUNTER to ensure adequate understanding of the information

68
Q

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

A

50%

69
Q

in the teach back method, what should you avoid?

A

quizzing the patient, using highly technical medical terms, appearing rushes, and asking yes/no questions

70
Q
A

Pharmaceutical Care FINAL (6 decks)

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