Treating HTN HB- Kohlenberg Flashcards
Approximately (blank) of patients do not take medications as prescribed
50%
T or F
Medications adherence is exclusively the responsibility of the patient
T
T or F
Increasing adherence may have a greater effect on health than improvements in specific medical therapy
T
Statins and antihypertensives have adherence rates below (blank)
(blank) percent do not fill initial statin prescription
50%.
58%
What is primary adherence?
do they fill the prescription
Antihypertensive therapy can reduce risk of stroke by (blank) and MI by (blank). As many as (blank) percent of patient treated for HT are nonadherent to their treatment regimen.
30%
15%
50-80%
WHO says lack of (blank) is the most important cause of failure to achieve BP control
adherence
Within 6 months to 1 year after being prescribed statins, (blank) percent of patients discontinue them.
At 2 years, (blank) percent of patients discontinue them.
25-50%
75%
Which of these drugs has the worst adherence? the Best adherence?
- antihypertensive therapy
- statins
- antiplatelet therapy
- warfarin
warfarin
antihypertensive
from best to worse
Antihypertensive> antiplatelet> statins> warfarin
What is compliance?
Implies that the patient passively follows the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between patient and physician.
What is adherence?
a collaborative model, with health care providers having some responsibility in creating the tx contract
What are some patient related factors that cause poor medication adherence?
Lack of understanding, lack of involvement, poor medical literacy.
In US, 90 million adults have poor health literacy
Health beliefs
Costs, transportation, support (a big problem with mood disorders and CVD)
What age group has the worst adherence?
older people; 20% of pnts over the age of 65 are adherent
(blank) is the greatest risk factor associated with increased incidence of HF in the elderly.
Medication nonadherence
T or F
Women are more nonadherent than men with antihypertensive medications
T
What are physician related factors to non adherence?
- physicians fail to recognize nonadherence (worse estimates when patient is high functioning)
- overly complex drug regiments, ineffective communication
- poor communication amongst physicians (discharge summaries are available at less than 34% of first post discharge visits)
What are health system factors related to non adherence?
Costs
lack of time
fragmented systems
poor coordination
What are strategies to improve medication adherence?
Educated well (patients recall as little as 50% of what is said) Empower patients (motivation and adherence will increase) Motivational Interviewing Avoid complicated regimens
Since not all people are health literate so what should you do to get patients to adhere ?
Make sure they understand, make sure they can read, simplify things, make it a shame free environment, recognize mental illness, tune into economic status
T or F
adherence is improved when a good relationship exists between patient and doctor
T
Patients reporting low ratings of patient-centered communication and trust with their personal clinician had (blank) worse nonadherence rates to medication refills compared with patients reporting high ratings after adjusting for clinical and sociodemographic characteristics.
7% to 16%
What is the cost of having diabetes per month?
$440.45
What are good questions a clinician can ask to assess a patient’s medication adherence?
- I know it must be difficult to take all your medications regularly. How often do you miss taking them?
- Of the medications prescribed to you, which ones are you taking?
- Have you had to stop any of your medications for any reason?
How can you reduce complexity?
- limit pharmacy visits
- adhere to formulary (an official list giving details of medicines that may be prescribed), respect economic realities
- reduce number of pills per day
What are ways the health system could help with adherence?
- phone reminders
- starting long term meds during hospital visit rather than after discharge may improve adherence.
- Med reconciliation (a list of all meds, including name, dose, frequency, route and comparing it with transfer/discharge orders)
A study with acute coronary syndrome patients had an intervention that utilized med reconciliation and tailoring, patient education, collaborative care b/w PCMD or cardiologist and pharmacist, 2 types of VM, educational and reminders. What did the results of this study show?
Improved adherence by 7% but did not improve clinical targets
Another study looked at patients with uncontrolled HTN, the intervention counted pills, family member was designated to support adherence behavior, education support to patients. What was the outcome?
Improved adherence (48 to 32%) but did not improve long term CV events
A study assessing primary adherence (prescription refilling) showed that if give a patient an automated phone reminder, they will (blank) their adherence
double
What happened in this study:
gave a bunch of obese people free gym memberships
Didnt help
What happened in this study:
conventional care vs house education program
no difference
What is early nonpersistance?
filling
What is nonadherence?
not having meds available for 20% or more days during 12 month following initiation of therapy
A study looked at different racial/ethnic differences in adherence, what did it show?
Non whites were more likely to exhibit early nonpersistence and nonadherence
It showed that health strategies such as reduced copays, ease of access to meds (mail order) and optimizing the choice for initial therapies narrow the gap.
(blank) are disproportionally affected by hypertension, and it explains most of the racial gap in mortality.
Poor medication adherence may explain poor BP control.
What can increase this adherence?
African Americans
Increased Positive affect (increased positive affect induction, self affirmation, look or positive feelings, unexpected gifts, induction of positive feelings)
PA is more effective than patient education!!!!!
In women, (blank) accounts for more than 50% of cardiac death
sudden cardiac death (SCD)
(blank) percent of SCD may be attributed to unhealthy lifestyle. How can you reduced this?
dont smoke, BMI less than 25. exercise 30 min per day or more, med, diet.
79%
(blank) is the most important factor in determining adherence to tx.
communication
Less time spent with the patient discussing meds is a strong predictor of lower adherence
What BMI do you want? How much exercise?
BMI less than 25
30 min per day or more
What is the spirit of MI?
- working together on a problem
- inspire, draw forth motivation from the person
- respecting people’s choices, their resources, whether or not they change
What is the PACE acronym for the spirit of motivational interviewing stand for?
Partnership
Acceptance
Compassion
Evocation
MI supports the patient in (blank)
articulating
(how personally important this change e.g dietary) is, as opposed to how important we think it is
What stands in the way of making this change (time, money, cultural factors, etc)
Changes that might work in their life
How to increase the chance of success
What are the four general techniques for motivational interviewing?
-express empathy
-develop discrepancy
-rolling with resistance (reflect, listen, validate)
-supporting self-efficacy
(less likely to make change if people don’t think they can. Build hope and confidence)
