PPHC 14: Drugs – How do we support medication taking as prescribed (adherence)? Flashcards
What is medication adherence?
extent to which a person’s behaviour (taking medication, following a diet, and/or executing lifestyle changes) corresponds with agreed recommendations from a healthcare provider
What is medication non-adherence?
process-related problems of medication adherence
What are the 3 types of medication non-adherence?
- non-acceptance
- poor-execution or implementation
- discontinuation
What is non-acceptance (non-initiation, primary non-adherence)?
patient does not fill prescription in first place
- initiates the process
- very hard to determine this type of non-adherence
What is poor-execution or implementation?
omitting doses, taking dose at wrong time, taking more medication than prescribed, not refilling
- characterizes the process
What is discontinuation?
stopping medications altogether – may be permanent or episodic
- terminates the process
What is persistence?
duration of therapy
- discontinuation and persistence are essentially reciprocal terms
What is compliance?
conforming to recommendations made by the provider with respect to timing, dosage, frequency of medication-taking
- synonymous with poor execution
- often used as a blanket term like ‘non-adherence’
- used interchangeably with ‘adherence’ but less preferred because it suggests patient’s passive obedience to health care provider’s orders
What is concordance?
agreement between the patient and clinician
- often used in sociological sciences
What are some other forms of non-adherence?
- taking more of a medication than prescribed
- taking a medication prescribed for someone else
- taking a dose with prohibited foods, liquids, and other medications
- taking outdated or damaged medications
- improper storage of medications
- improper use of medication administration devices (ie. inhalers)
Describe the number of medications by number of chronic diseases.
- 1 chronic disease → average 3 prescription meds
- 2 chronic diseases → average 4 prescription meds
- ≥3 chronic diseases → average 6 prescription meds
(adherence to long-term therapy for chronic illnesses in developed countries averages 50%)
Describe the impacts of medication non-adherence in numbers.
- non-acceptance: 12%
- poor execution: 12%
- discontinuation: 29%
- result: 47% of prescriptions are continued
Describe the impacts of medication non-adherence.
- when patient does not fill prescription in the first place, cannot derive any therapeutic benefit
- when patient does not execute the dosing as prescribed, transient interruptions in drug action
- when patient discontinues their medication, permanent loss of drug effects (short and long-term impacts)
Describe the cycle of medication non-adherence.
- medication non-adherence
- no therapeutic benefit
- unnecessary disease progression
- adverse outcomes – complications (hospitalization, early mortality, need for more medications, disability, loss time from work), unnecessary, costly
What are the 5 dimensions of medication non-adherence?
- patient-related
- condition-related
- therapy-related
- health care team and system-related
- social and economic factors
5 Dimensions of Non-Adherence
Patient-related
resources, knowledge, attitudes, beliefs, perceptions, and expectations
- forgetfulness, anxiety about side effects, inadequate knowledge to manage disease
5 Dimensions of Non-Adherence
Condition-related
particular illness-related demands faced by patient
- severity, symptoms, co-morbidities (ie. having other conditions)
5 Dimensions of Non-Adherence
Therapy-related
related to complexity of regimen, duration, immediacy of beneficial effects, side effects
5 Dimensions of Non-Adherence
Health Care Team and System-related
- health care team: interactions between patient and health care providers
- system: access (ie. living in rural communities), continuity of care (ie. not having GP), patient education material not written in plain language
5 Dimensions of Non-Adherence
Social and Economic Factors
goes back to notion that medication taking is not an isolated process and subject to patient’s social and economic environment
- social factors: lack of family or social support, unstable living conditions
- economic factors: having health insurance coverage, costs of medications
What are the 2 types/nature of non-adherence?
- non-intentional non-adherence
- intentional non-adherence
(patients can, and often do, exhibit both types of non-adherent behaviours)
What is non-intentional non-adherence?
passive process whereby patients fail to adhere to prescribing instructions through forgetfulness, carelessness or circumstances out of their control (ie. health literacy)
- logistical
- related to patients’ ability or resources to take medications
- ie. forgetting doses, forgetting to refill, external, distractors (ie. childcare, work), misunderstanding instructions, irregular schedule, cost problems
What is intentional non-adherence?
active decision on the part of the patient to forego prescribed therapy
- emotional
- related to patients’ motivation to take medications and beliefs about medications
- ie. less severe disease, concerns about side-effects, perceived benefits, stigma of taking medication, adjustment to suit daily routine, concerns about dependency, concerns about cost
Why are pharmacists important for addressing medication non-adherence?
- trusted medication experts
- most accessible provider (particularly community pharmacists)
- key touch point throughout continuum of health care
- last health care professional seen by patient before medications are taken – patient education
- pharmacists are highly prevalent primary care providers – contact with patients up to 8 times more than physicians
How can pharmacists target non-adherence?
- education – translating medication information in a patient-friendly manner, counselling on interactions and side effects
- cost – identifying cost-effective alternatives that are clinically appropriate
- regimen complexity – packaging (ie. blister packs), refill reminders, reduced dosing frequency, refill coordination
