Supporting patients to use medicines safely Flashcards
What is compliance (4)
- Core of paternalistic care
- Extent to which the patient follows the prescribers instructions
- Patient holds responsibility for medicine taking
- Patient told off when instructions not followed
What is adherence (3)
- Adherence now used as less stigmatising term
- Extent to which the patient follows the treatment regimen agreed with the prescriber
- In truly concordant relationships, intentional non-adherence minimised
What is concordance (5)
- Describes the relationship between the patient and a health professional
- Patient has right to make informed choice about treatment (Standards for Pharmacy Professionals)
- Open discussion about risks and benefits of treatment
- Patient is equal partner with health professional
- Decisions on treatment, including non-drug treatment, made in collaboration
What is unintentional non-adherence (2)
- Patient tries to follow instructions, but fails to use as prescribed
- Manage through reduced barriers and practical support
What is intentional adherence (5)
- Conscious choice
- Medicine not taken
- Prescribed regimen not followed
- Often related to non-concordant relationship
- Manage by collaborating with patient
What are the reasons non-adherence for non-adherence rarely openly being reported (3)
- Fear of chastisement
- Embarrassment
- Not wishing to appear ungrateful for treatment
Why are 30-50% of patients not taking their medication as prescribed (3)
- Higher/more frequent dose
- Lower/less frequent dose
- Not using at all
What are examples of reasons for intentional non-adherence (7)
- Patient’s view on whether medicine will work (brands vs generic & media reports)
- That regular use will reduce effectiveness (antibiotics & analgesics)
- Patient’s own understanding of risks & benefits (parents, beliefs around condition and/or treatment)
- Belief that natural therapies are better/safer
- Concerns over medicalisation (social problem/illness, menopausal symptoms, antidepressants & anxiolytics)
- The patient’s excessive concern over addiction & dependence
- Misunderstanding & confusion (’steroids are used by bodybuilders’)
How does understanding the condition affect patients’ use of medicines (4)
- Denial of diagnosis
- Need to understand what is wrong
- How did the patient get the condition
- What causes it
What is an appreciation of the clinical need (4)
- How does the medicine help
- What are the alternatives
- What are the risks/benefits of using this medicine
- Duration of treatment
What are the problem areas of intentional non-adherence (6)
- preventative medicines (prophylaxis)
example:
- Coronary heart disease and stroke
- Asthma (steroids)
- Motivation important
- Risk/benefit
- lack of obvious symptoms/belief about long-term issues e.g. diabetes
Cost of using drugs
- NHS levy
- OTC medicines
- More prevalent issue outside of the UK
How can packaging affect unintentional non-adherence (4)
- Ensure that patient can identify and access their medicines
- Labelling -clearly identify appropriate medicine (consider literacy)
- Closures - Child Resistant Cap (CRC), Blister packs
- Limited manual dexterity
How does dosage form affect unintentional non-adherence (7)
- Swallowing difficulties - Can patient swallow tablets/capsules (check sizes)
- Consider using liquids or soluble/chewable tablets if they are available
- Specially manufactured products
- Flavour/presentation may be off-putting
- Respect personal preferences(suppositories; pessaries)
- Operation of devices - Applicators (creams, intraurethral etc)
- Inhalers (Asthma; COPD) - Check technique
How does understanding how to use medicine affect unintentional non-adherence (6)
- What is it for - prn (when required)
- How to take
- Missed doses
- How to store
- How does it work
- What does it do to the body
How does understanding the regimen affect unintentional non-adherence
- When to take
- Frequency of administration
- Longer-acting medication – once daily administration
- Weekly and monthly dosages can be problematic
- Coincide dosing for multiple agents - Atorvastatin – take in the morning
- Combination & advanced dosage forms
- Combine drugs in single dosage form
- Reduce the number of tablets
- Asymmetrical drug release
- Monitored dosage systems (MDS)
- Memory issues/confusion
How do interactions affect unintentional patient adherence (3)
- Does the medicine interact with other products
- What can be done to minimise harm/risks
- Drug/food interactions
How does adverse effects affect unintentional patient adherence (4)
- What adverse effects should (or could) the patient expect
- What are the relative risks of them occurring
- What can they do to manage them?
- Lifestyle adaptations
How can you support medicine use by raising the topic (7)
- Important not to ‘blame’
- Avoid language such as ‘need to’ and ‘must’
- Collaborative approach
- Concordant relationship
- Empathise
- Patient’s views are important
- Tailor approach to individual patients circumstances
How can you support medicine use through information (5)
- Provided in a format that the patient can understand?
- Verbal - Explain complex things, keep key points to a maximum of 5
- Written - Literacy, Limit complex language
- Visual impairment - Large print
- Always use written information to support verbal, never in place of
