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PHRM 100 – PPHC > PPHC 14: Drugs – How do we support medication taking as prescribed (adherence)? > Flashcards

PPHC 14: Drugs – How do we support medication taking as prescribed (adherence)? Flashcards

1
Q

What is medication adherence?

A

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

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2
Q

What is medication non-adherence?

A

process-related problems of medication adherence

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3
Q

What are the 3 types of medication non-adherence?

A
  • non-acceptance
  • poor-execution or implementation
  • discontinuation
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4
Q

What is non-acceptance (non-initiation, primary non-adherence)?

A

patient does not fill prescription in first place

  • initiates the process
  • very hard to determine this type of non-adherence
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5
Q

What is poor-execution or implementation?

A

omitting doses, taking dose at wrong time, taking more medication than prescribed, not refilling

  • characterizes the process
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6
Q

What is discontinuation?

A

stopping medications altogether – may be permanent or episodic

  • terminates the process
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7
Q

What is persistence?

A

duration of therapy

  • discontinuation and persistence are essentially reciprocal terms
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8
Q

What is compliance?

A

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
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9
Q

What is concordance?

A

agreement between the patient and clinician

  • often used in sociological sciences
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10
Q

What are some other forms of non-adherence?

A
  • 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)
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11
Q

Describe the number of medications by number of chronic diseases.

A
  • 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%)

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12
Q

Describe the impacts of medication non-adherence in numbers.

A
  • non-acceptance: 12%
  • poor execution: 12%
  • discontinuation: 29%
  • result: 47% of prescriptions are continued
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13
Q

Describe the impacts of medication non-adherence.

A
  • 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)
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14
Q

Describe the cycle of medication non-adherence.

A
  • 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
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15
Q

What are the 5 dimensions of medication non-adherence?

A
  • patient-related
  • condition-related
  • therapy-related
  • health care team and system-related
  • social and economic factors
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16
Q

5 Dimensions of Non-Adherence

Patient-related

A

resources, knowledge, attitudes, beliefs, perceptions, and expectations

  • forgetfulness, anxiety about side effects, inadequate knowledge to manage disease
17
Q

5 Dimensions of Non-Adherence

Condition-related

A

particular illness-related demands faced by patient

  • severity, symptoms, co-morbidities (ie. having other conditions)
18
Q

5 Dimensions of Non-Adherence

Therapy-related

A

related to complexity of regimen, duration, immediacy of beneficial effects, side effects

19
Q

5 Dimensions of Non-Adherence

Health Care Team and System-related

A
  • 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
20
Q

5 Dimensions of Non-Adherence

Social and Economic Factors

A

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
21
Q

What are the 2 types/nature of non-adherence?

A
  • non-intentional non-adherence
  • intentional non-adherence

(patients can, and often do, exhibit both types of non-adherent behaviours)

22
Q

What is non-intentional non-adherence?

A

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
23
Q

What is intentional non-adherence?

A

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
24
Q

Why are pharmacists important for addressing medication non-adherence?

A
  • 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
25
Q

How can pharmacists target non-adherence?

A
  • 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

PHRM 100 – PPHC (18 decks)

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