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1. Daniel Bediako, Pharm.D Candidate 2015 Sarah Amering,
Pharm.D; BCACP Ruth Fertel/Tulane University Community Health
Center September, 2014 Medication Adherence 1
2. Objectives Define medication adherence Identify some
benefits of medication adherence Provide statistics on medication
nonadherence Emphasize the economic burden of med. nonadherence
Explain the five dimensions of medication nonadherence Suggest
practical strategies to improve medication adherence 2
3. What is Medication Adherence? It refers to the patients
conformance with the providers recommendation with respect to
timing, dosage, and frequency of medication-taking during the
prescribed length of time. Source: WHO 2003 3
4. Benefits of Medication Adherence Enhances patient safety
Decreases health care costs Improves long-term therapies and
outcomes Good investment for tackling chronic conditions 4
5. Med. Non-adherence Statistics Patients with psychiatric
disabilities are less likely to be compliant Overall, about 20% to
50% of patients are non-adherent to medical therapy Nonadherence to
medications is estimated to cause 125,000 deaths annually People
with chronic conditions only take about half of their prescribed
medications 5
6. Med. Non-adherence Statistics Adherence drops with long
waiting times at clinics or long time lapses between appointments 1
in 5 patients started on warfarin therapy for atrial fibrillation
discontinue therapy within 1 year Adherence to treatment regimens
for high blood pressures is estimated to be between 50% and 70 %
Rates of adherence have not changed much in the last 3 decades,
despite WHO and Institute of Medicine (IOM) improvement goals
6
7. Cost of Medication Non-adherence Annually, non-adherence
costs $2,000 per patient in physician visits Nonadherence results
in an economic burden of $100 to $300 billion per year Nonadherence
accounts for 10% to 25% of hospital and nursing home admissions The
rate of non-adherence is expected to increase as the burden of
chronic disease increases Revenue loss by major pharmaceutical
class Source: Capgemini Group (pls. refer to last sheet) 7
8. The Five Dimensions Of Non-adherence Defines adherence as a
multidimensional phenomenon determined by the interplay of five
sets of factors. A holistic approach to address improve medication
adherence. These dimensions interact with one another. Are patients
solely responsible for taking their treatments? 8
9. The Five Dimensions Of Non-Adherence 9
10. The Five Dimensions Of Non-Adherence Socio-economic factors
Poverty Illiteracy Unemployment Family dysfunction High cost of
transport High cost of medication Low level of education Poor
socioeconomic status Unstable living conditions Long distance from
treatment centre Condition-Related factors Disability level
Follow-up treatment, Emphasis on adherence Available effective
treatments Progression /severity of the disease Co-morbidities
(e.g. Depression and drug/alcohol abuse) 10
11. The Five Dimensions Of Non-Adherence Therapy-Related
factors Side-effects Treatment duration Available medical support
Complex medical regimen Previous treatment failures Immediate
beneficial effects Frequent changes in treatment Patient-Related
factors Forgetfulness Low motivation Psychosocial stress Disbelief
in the diagnosis Low treatment expectations Low attendance at
follow-up Lack of acceptance of monitoring Disease symptoms and
treatment Hopelessness and negative feelings 11
12. The Five Dimensions Of Non-Adherence Health systems factors
Short consultations Poor health services Interventions for
improving it Overworked health care providers Poor medication
distribution systems Inadequate training for health care providers
Lack of incentives and feedback on performance Lack of knowledge on
adherence and of effective Weak capacity of the system to educate
patients and provide follow-up Inability to establish community
support and self-management capacity 12
13. Strategies to Improve Med. Adherence The SIMPLE approach o
S Simplify the regimen o I Impart knowledge o M Modify patient
beliefs and behavior o P Provide communication and trust o L Leave
the bias o E Evaluate adherence 13
14. SSimplify the Regimen Encourage use of adherence aids.
Investigate customized packaging for patients Adjust timing,
frequency, amount, and dosage Match regimen to patients activities
of daily living Consider changing the situation vs. changing the
patient Avoid prescribing medications with special requirements
Recommend taking all medications at the same time of day 14
15. IImpart Knowledge Advise on how to cope with medication
costs Focus on patient-provider shared decision making Involve
patients family or caregiver if appropriate Keep the team informed
(physicians, nurses, pharmacists) Provide all prescription
instructions clearly in writing and verbally Reinforce all
discussions often, especially for low-literacy patients Suggest
additional information from Internet for interested patients
15
16. MModify Patient Beliefs and Behavior Address fears and
concerns Provide rewards for adherence Empower patients to
self-manage their condition Ask patients about the consequences of
not taking their medications Have patients restate the positive
benefits of taking their medications Ensure that patients
understand their risks if they dont take their medications 16
17. PProvide Communication and Trust Use plain language
Practice active listening Provide emotional support Improve
interviewing skills Elicit patients input in treatment decisions
17
18. LLeave the Bias Develop patient-centered communication
style Acknowledge biases in medical decision making Understand
health literacy and how it affects outcomes Address dissonance of
patient-provider, race-ethnicity, and language Examine
self-efficacy regarding care of racial, ethnic, and social minority
populations 18
19. EEvaluating Adherence Self-report Ask about adherence
behavior at every visit Periodically review patients medication
containers, noting renewal dates Use biochemical testsmeasure serum
or urine medication levels as needed Use medication adherence
scales e.g. Morisky-8 (MMAS-8), Medication Possession Ratio (MPR),
Proportion of Days Covered (PDC) 19
20. Question The economic burden of medication non-adherence:
who is to blame? 20
21. Works Cited Agency for Healthcare Research and Quality
(2012). Medication Adherence Interventions: Comparative
Effectiveness Closing the Quality Gap: Revisiting the State of the
Science American College of Preventive Medicine
http://www.acpm.org/?MedAdherTT_ClinRef (9/07/2014) Capgemini
Consulting (2011) Estimated Annual Pharmaceutical Revenue Loss Due
to Medication Non-Adherence Centers for Disease Control and
Prevention. Noon Conference: Medication Adherence. (03/27/2013)
Hugtenburg, J., Timmers, L., Elders, P., Vervloet, M., & van
Dijk, L. (2013). Definitions, variants, and causes of nonadherence
with medication: a challenge for tailored interventions. Patient
Preference And Adherence, 7675-682. WHO (2003). Adherence to
Long-Term Therapies Evidence for Action, Geneva, Switzerland
21