Affording and Taking Immunosuppressive and Other Medications Tracy Anderson-Haag, Pharm.D., BCPS Clinical Pharmacy Special...
Over the next few minutes I am going to talk about: <ul><li>Why it is vital to continue taking prescribed medications afte...
Importance of Adherence <ul><li>Adherence involves taking your medications and following advised instructions for labs and...
Risk of Non-Adherence to Graft <ul><li>3 rd  leading cause of graft failure </li></ul><ul><li>1/3 of graft loss in kidney ...
Why is this so hard? <ul><li>Life </li></ul><ul><ul><li>Many tx patients have a great QOL </li></ul></ul><ul><ul><li>Busy ...
What can we ALL do to improve adherence? <ul><li>Understand your medication regimen </li></ul><ul><ul><li>If you know why ...
Pharmacist Access <ul><li>Community Pharmacist </li></ul><ul><ul><li>Fills your prescriptions </li></ul></ul><ul><ul><li>M...
Tx Patients on complex regimens <ul><li>When your transplant pharmacist evaluates your medication profile they look for </...
Tx Patients on complex regimens <ul><li>Trust your transplant team </li></ul><ul><ul><li>Be honest about your adherence </...
Summary <ul><li>Adherence isn’t always easy! </li></ul><ul><li>Poor adherence can lead to acute rejection, worse graft fun...
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Adherence Coffee Talk

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  • Taking meds as prescribed: not self increasing or decreasing doses, not self starting or stopping medications without consulting MD Monitoring levels: may be at routine f/u points or after dose adjustments or medication changes. Many medications can affect levels of immunosuppressive and other medications. We know low levels of immunosuppression can lead to rejection. High levels of immunosuppression can lead to troublesome side effects, including damage to graft organ and specifically with CSA or tacrolimus damage to the kidneys.
  • Most data is in kidney transplants Nonadherence is a risk factor for acute rejection, and acute rejection is a risk factor for higher SCr and chronic rejection (allograft dysfunction), worse graft survival.
  • Knowing repercussions, including significant risk to transplant and patient health why is this so common? Most common reasons for missing or skipping doses…”I forgot”, or competing priorities. Lack of knowledge about regimen, illness, consequences Depression/cognitive impairment
  • Understand regimen-take time to learn indications of meds. Ask questions. Establish routine-won’t happen overnight. Use tools like med boxes and alarms or other reminders to help with med dosing. Challenge your transplant team to address barriers to med and treatment adherence
  • Two main pharmacist access options. Using one pharmacy for all meds improves safety for you!
  • You may have the option to set up an appointment specifically with your tx pharmacist, or ask to see or speak with a pharmacist at your routine clinic visit. Is it worth the extra time? Absolutely. Medication experts and specially trained in transplant issues and related problems. We can identify unecessary medications (not always there), meds causing side effects that are leading to non adherence. Also familiar with dosage forms or medications that can reduce the number of dosing times/day.
  • Your transplant team can empathize with you-we know the regimens we ask you to adhere to are complex. In order to get the best results for you, we need to have good communication and work together.
  • Adherence Coffee Talk

    1. 1. Affording and Taking Immunosuppressive and Other Medications Tracy Anderson-Haag, Pharm.D., BCPS Clinical Pharmacy Specialist Hennepin County Medical Center Clinical Assistant Professor University of Minnesota, College of Pharmacy Minneapolis, MN
    2. 2. Over the next few minutes I am going to talk about: <ul><li>Why it is vital to continue taking prescribed medications after transplant </li></ul><ul><li>Repercussions of missing medications and non adherence </li></ul><ul><li>The importance of having routine labs and seeing your transplant team for the life of your transplant </li></ul><ul><li>Ideas to help improve adherence-patient and transplant team role </li></ul>
    3. 3. Importance of Adherence <ul><li>Adherence involves taking your medications and following advised instructions for labs and f/u </li></ul><ul><li>Medication Adherence </li></ul><ul><ul><li>Taking medications as prescribed </li></ul></ul><ul><ul><li>Having levels monitored on recommended schedule </li></ul></ul><ul><li>Rates ~ 25% of transplant patients are non-adherent; higher rates miss occasional doses of medications </li></ul><ul><ul><li>Nonadherence increases over time </li></ul></ul><ul><ul><li>Starts increasing significantly within 6-9 months of transplant </li></ul></ul>
    4. 4. Risk of Non-Adherence to Graft <ul><li>3 rd leading cause of graft failure </li></ul><ul><li>1/3 of graft loss in kidney tx associated with prior nonadherence </li></ul><ul><li>Odds of graft failure 7 fold higher in nonadherent patients </li></ul><ul><li>53% of rejections after 6 months post tx (later rejections) associated with nonadherence (one study) </li></ul><ul><li>More rejection, more graft loss, and higher SCr if nonadherent </li></ul>
    5. 5. Why is this so hard? <ul><li>Life </li></ul><ul><ul><li>Many tx patients have a great QOL </li></ul></ul><ul><ul><li>Busy schedules interfere with med regimen </li></ul></ul><ul><ul><ul><li>Forget, inconvenient to take </li></ul></ul></ul><ul><ul><li>Feel so good, do I really need the meds (especially when they make me feel worse!)? </li></ul></ul><ul><ul><ul><li>Potentially no immediate consequence ‘felt’ when misses meds (BP, DM, Immunos, antidep, supps) </li></ul></ul></ul><ul><ul><li>Complex post transplant regimens (many meds, TID/QID dosing, many comorbidities & clinic visits) </li></ul></ul><ul><li>Money </li></ul><ul><ul><li>Medications are often expensive </li></ul></ul><ul><ul><li>On many meds; even if low copay this adds up </li></ul></ul>
    6. 6. What can we ALL do to improve adherence? <ul><li>Understand your medication regimen </li></ul><ul><ul><li>If you know why you’re taking the meds, more likely to buy into importance of adherence </li></ul></ul><ul><li>Establish routine </li></ul><ul><li>Involve support system (family, friends, coworkers) </li></ul><ul><li>Enlist help of transplant team </li></ul><ul><ul><li>Pharmacists are a part of your team-great resource for med information and questions </li></ul></ul><ul><ul><li>Simplify med regimen if possible (next slides) </li></ul></ul><ul><ul><li>Address financial needs (SW) </li></ul></ul>
    7. 7. Pharmacist Access <ul><li>Community Pharmacist </li></ul><ul><ul><li>Fills your prescriptions </li></ul></ul><ul><ul><li>May or may not know all active medications if using > 1 pharmacy </li></ul></ul><ul><ul><li>Can help identify interactions and dosing issues with medications filled at that pharmacy </li></ul></ul><ul><li>Transplant Pharmacist </li></ul><ul><ul><li>Special training in transplant </li></ul></ul><ul><ul><li>Intensive medication reviews </li></ul></ul><ul><ul><li>Face to face interactions/advanced counseling </li></ul></ul><ul><ul><li>Able to work more efficiently (directly) with transplant team </li></ul></ul>
    8. 8. Tx Patients on complex regimens <ul><li>When your transplant pharmacist evaluates your medication profile they look for </li></ul><ul><ul><li>Excessive or unnecessary use of prescription or nonprescription medications </li></ul></ul><ul><ul><ul><li>Taking prescription or OTC medications that have no apparent indication or duplicate medications to treat the same disease </li></ul></ul></ul><ul><ul><ul><li>Concurrent use of interacting medications </li></ul></ul></ul><ul><ul><ul><li>Use of an inappropriate dosage </li></ul></ul></ul><ul><ul><ul><ul><li>Medications not optimized before adding more </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Up titration of medications to max dose/effect </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Desired result not obtained +/- adverse effect present </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Use of drug therapy to treat side effects </li></ul></ul></ul><ul><ul><ul><li>Too many doses a day: QD=79% adherence, BID, 69%, TID: 65%, QID 51%. </li></ul></ul></ul>
    9. 9. Tx Patients on complex regimens <ul><li>Trust your transplant team </li></ul><ul><ul><li>Be honest about your adherence </li></ul></ul><ul><ul><li>Help identify barriers to your medical adherence-medications, labs and visits </li></ul></ul><ul><ul><li>Together we may be able to find solutions to improve adherence and outcomes </li></ul></ul>
    10. 10. Summary <ul><li>Adherence isn’t always easy! </li></ul><ul><li>Poor adherence can lead to acute rejection, worse graft function and loss of graft </li></ul><ul><li>Utilize resources like your transplant team to improve success with adherence to regimen </li></ul><ul><li>Develop good medication and behavioral habits to support adherence </li></ul>
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