Medication Adherence and Assessment Flashcards
Adherence
The extent to which a person’s behavior corresponds with agreed upon recommendations from a health care provider
Medication adherence
The patient’s conformance with the provider’s recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time
Persistence
Duration of time patient takes medication, from initiation to discontinuation of therapy
Primary Nonadherence
Primary nonadherence occurs when NEW prescriptions are never filled or picked up at the pharmacy
What are some reasons primary medication nonadherence are studied less than nonadherence associated with filled prescriptions?
- Use of pharmacy claims data for adherence research
- Cumbersome nature of reviewing office records for prescribed drugs and comparing to pharmacy records or claims data or reviewing data at the pharmacy level
What are some predictors for primary nonadherence?
- Low income
- Minority race
- Patient prescribed a greater number of medications
- Prescriptions written by primary care providers
- Pain medications are the least likely drugs to be filled
- Treatment of chronic conditions such as diabetes, hyperlipidemia, hypertension, especially for newly prescribed medication
Intentional nonadherence
Nonadherence based on an active, reasoned decision-making process
Unintentional nonadherence
Nonadherence that results from a more passive process
What are the 5 sets of factors that influence medication adherence?
- Social/economic factors
- Therapy-related factors
- Patient-related factors
- Condition-related factors
- Health system/healthcare team factors
Proportion of Days Covered (PDC)
(Sum of days covered by prescription fills)/(Sum of days between first fill and end date of evaluation period )
* 80% is used to identify patient with good adherence
* Pharmacy Quality Alliance (PQA) endorses this over MPR
* Way to measure adherence
What are some advantages of medication adherence tools/questionnaires?
- Measure true medication taking behaviors
- Ascertain reasons behind nonadherence
- Low cost
- Easy to administer
- Flexibility in timing of administration
What are some disadvantages of medication adherence tools/questionnaires?
- Subject to patient recall and truthfulness
- Take time to administer
- No tool measures all potential nonadherence factors
- Validity of tools
Morisky Medication Adherence Scale
- 4 item scale
- Can be easily administered to patients
- Validated in low-literacy patients
- Con: Economic factors not assessed
Medication Adherence Report Scale (MARS-5)
- Measures unintentional and intentional nonadherence
- 5-point Likert scale
- Can be self-administered by patient
Self-Efficacy
The belief or confidence that a person can successfully perform a specific action to achieve a desired outcome
SEAMS (Self Efficacy for Appropriate Medication Use Scale)
- Applies the concept of self-efficacy to medication management
- Validated in several chronic diseases and in low literacy patients
- 13 item scale
- 3-point Likert scale
What are some issues with SEAMS?
- 13 items may be cumbersome to administer in a busy practice
- Not clear how to use this scale/results in practice
- Doesn’t address economic factors for nonadherence
MUSE (Medication Understanding and Use Self-Efficacy Scale)
- Measures self-efficacy of understanding and using prescription medications
- Measures an individual’s perceived ability to seek out and understand their medications and to adhere to prescribed regimens
- Can be used in low-literacy patients
- 8 items with 4 point Likert response scale
- Could be utilized to evaluate the impact of pharmacist adherence and education interventions (e.g., CMR; MTM)
- Doesn’t address economic or therapy-related factors for nonadherence
What is the population for BMQ (Brief Medication Questionnaire)
- Diabetes, Depression, Hypertension (ACE inhibitors)
Complicated to administer and score
What is the population for Hill-Bone Compliance Scale?
Hypertension
What is the population for Adherence to Asthma Medication Questionnaire (AAMQ)?
Asthma
Adherence to Asthma Medication Questionnaire (AAMQ)
- 13 items with Likert Scale response
- Wording specific to asthma including use of inhalers
- Total scores correlate with excellent, moderate, and poor adherence
