Social issues & adherence Flashcards
What is the best way to ask medication adherence? (2)
You are on a lot of medications. How do you manage to take them every day? (not do you take your meds?)
How many days in a week would you miss your medications? and why?
What are the key questions to assess patient’s adherence?
(4)
- Do they manage to take their meds? If misses, why?
- What do they do when they forget? double-dosing?
- Which medications do they not want to take and why?
- Other non-adherence behaviours: BSLs, INRs, missing appointments.
How would you confirm that patient has adherence issues? (3)
Pill counts
Ascertaining rates of refilling prescriptions
Patient questionnaires
Medication diary
What are the common causes of medication non-adherence? (4 categories).
Patient factors: lack of belief, poor understanding, level of education, psychological (depression), cognitive impairment.
Disease factors: treatment of asymptomatic disease
Doctor factors: suboptimal therapeutic alliance
Medication factors: side effects, pill burden, dosing frequency, cost, barrier to obtaining medications
What is your approach to improving this patient’s medication adherence?
Confirm dx: pharmacist (rate of refilling medications), consider pill count, speak to family/GP
A: screen for depression, cognitive impairment and treat. Ensure patient doesn’t have any barriers to obtaining medications (e.g. transport)
Management
- Educate: importance of tx, complications with simple language. Explain expected side effects. Involve family, GP and pharmacist. Written information. Support groups
- Simplify dosing schedules: pillboxes/webster pack, daily dosing (instead of bd), slow-release formulations, transdermal patches, combined pills
- Reminders: enlist family member, apps
- Access to medications: home deliver (some pharmacies do), compassionate access
Ensure follow-up
How would you improve this patient’s insight?
- Why is it important*: improves adherence, foster self-efficacy
- Why is it happening:* depression, dementia, lack of explanation?
- Management*
- Rule out underlying depression or cognitive impairment
- A dedicated session for education
- Involve family & local doctor for continued support & encouragement
- Community groups, website
- Provide written information: health conditions, medications
- Medic-alerts
What is your approach to social isolation?
Why is it important: affects QOL, mortality, mood disorders
Why is it happening: mood? finance problems? mobility problems?
How will I approach it:
- Identify and treat (dementia, depression)
- Finance: involve SW & ensure patient is on an eligible support scheme
- Mobility: ensure pain is under control, improve access (mobility scooters, community transport)
- Make opportunities to meet people and socialize: link in with community groups (e.g. Men’s Shed, day centres, RSL clubs, church, disease specific groups, Bingo groups.
- Pets & therapy dogs
How would you address geographic isolation?
Why is it important
- Difficulty attending appointments and getting medications
- Challenging emergency care
- Risk for social isolation + mental disorders
Management
- Screen and treat depression & cognitive impairment
- Ensure Action plan is in place, including contact numbers
- Simplify: pool appointments together
- Home deliver meds
- Make use of Telehealth & skype
- Community transport
- Ensure patient is on eligible support scheme (e.g. NDIS)
- Engage outreach services
How would you approach this patient’s financial difficulties?
Why is it important: affects adherence, well-being, depression (e.g. patient would not be keen to have HBA1C checked for example)
Why is it happening: physical difficulties, mood disorders
Management
- Screen for depression & cognitive impairment and treat.
- Bulk billing
- Use PBS listed medications
- Rationalise: decrease pill-burden, cease unnecessary, find cheaper alternative
- Financial support scheme: NDIS, disability support pension
- Help finding work: DES (disability employment services), retraining options (skill support scheme) - assess which schemes realistically patient would benefit from
- Housing assistance (e.g. Barnados, DOH)
- Low income healthcare card
