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3.3. The Reality of Non-Compliance
 

3.3. The Reality of Non-Compliance

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    3.3. The Reality of Non-Compliance 3.3. The Reality of Non-Compliance Presentation Transcript

    • The Reality of Non-Compliance
      GreenPharmEdu.org
    • Non-compliance or Non-adherence
      Non-complianceoccurs when a patient fails to take medication as directed.
      Also called Non-adherence or Concordance
      There are many forms and subtleties, often these terms are used interchangeably.
    • Non-Compliance
      Purposeful deviation from prescribed directions
      Can be conscious or unconscious
      Under-adherence or over-adherence
      Major cause of wasted drugs
      Various sources site occurrence about 50%
    • Sorensen et al (2005)
      Medication management at home: medication risk factor prevalence and inter-relationships
      “The number of medications present in a home serves to reflect poor healthcare outcomes more reliably then the number of medications a patient is aware of taking.”
      Poor storage strategies and accumulated medications are strongly correlated with adverse healthcare outcomes.
      Sorensen, L. Stokes, LA, Purdie DM, Woodward M, Roberts MS, 2005, Medication management at home: medication risk factor prevalence and inter-relationships Journal of Clinical Pharmacy and Therapeutics Volume 31, Issue 5, pages 485–491, October 2006
    • National Council on Patient Information and Education
      Half polled said they had forgotten to take a prescribed medicine
      One third prematurely ceased treatment
      One quarter used less than recommended dose
      One third failed to fill prescriptions
      Enhancing Prescription Medicine Adherence: A National Action Plan
      http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf
    • Four common manifestations
      Forgot to take medications as directed
      Failed to fill a prescription
      Taking less then recommended dose or early discontinuation
      Substituting OTC in place of filling a prescription
    • Resisting Medications
      “Widespread caution about taking medicines highlighted the lay practice of testing medicines, mainly for adverse effects.”
      “The main reason why people do not take their medicines as prescribed is not because of failings in patients, doctors or systems.
      “On the whole, the findings point to considerable reluctance to take medicine and a preference to take as little as possible.”
      Pound, P Britten, Morgan, M Yardley, L, Pope, C, Daker-White, Campbell, R (2005) Resisting medicines: a synthesis of qualitative studies of medicine taking. Social Science and Medicine, 2005 61(1): 133-155
      https://files.pbworks.com/download/Peykf61J6W/europharm/19341793/Pound_2005%5B1%5D.pdf
    • Pound et al
      “We argue that peoples’ resistance to medicine taking needs to be recognized and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicines
      Pound, P Britten, Morgan, M Yardley, L, Pope, C, Daker-White, Campbell, R (2005) Resisting medicines: a synthesis of qualitative studies of medicine taking. Social Science and Medicine, 2005 61(1): 133-155
      https://files.pbworks.com/download/Peykf61J6W/europharm/19341793/Pound_2005%5B1%5D.pdf
    • Medicines non-use in primary care
      Dislike by patient for using drugs
      Fear of becoming addicted to non-addictive drugs
      Fear of long-term adverse effects
      Distrust of physicians
      Belief that prescription is unnecessary
      Belief that that taking a medication confirms the illness
      Mackridge AJ, Medicines Non-Use in Primary Care. 2007; Aston University, Birmingham
      http://mackridge.com/wp-content/uploads/2008/12/complete-thesis-web.pdf
    • Costs
      Prescriptions costs are too high
      Desire to conserve medications for future use by hording, skipping doses or splitting does
      Costs high enough that consumers continue to hand on to medications beyond actual utility.
      Kennedy, J,& Christopher Erb, C (2002) Prescription Noncompliance due to Cost Among Adults With Disabilities in the United States, American Journal of Public Health | July 2002, Vol 92, No. 7
      http://ajph.aphapublications.org/cgi/reprint/92/7/1120.pdf
    • Cover up
      Some patients continue to reorder medications in order to hide this lack of compliance!
      Auto-refills and mail order pharmacies make this worse!
      Braund, R.; Peake, B. M.; Shieffelbien, L.Disposal practices for unused medications in New Zealand, Environment International2009 Vol. 35 No. 6 pp. 952-955
    • Consequences of Poly-pharmacy
      As number of medications increases,
      so do non-compliance rates!
      One in four seniors
      take between 10 and 19 pills daily!
      Any number over three prescriptions
      is associated with greater non-compliance!
      Van Dusen, A (2009) Are you taking too many medications? Forbes.com, July 19
      http://www.forbes.com/2008/06/19/health-drugs-prescriptions-forbeslife-cx_avd_0619health.html
    • Brown-bag Medication Review
      More effective drug usage is effected by awarenessfor both physician and patient.
      Linkages between drug life-cycle is key to reducing a variety of issues.
      Ask patients to bring in all their medications for a review-prescriptions and OTC
      Can reveal medications from other physcians
      Allows for dosage adjusting
      Builds collaborative ‘shared-decision making”
    • Asynchronous prescribing
      Patients with on several prescriptions have refill cycles out of sync.
      This can lead to over prescription or under-utilization
      Coventry Teaching PCT 2007
      http://reports.pmetbtrainingsurveys.org/IndicatorScores.aspx?agg=AGG01|2007&groupcluster=5MD
    • Prescriber and Rational Prescribing
      Prescribers role have an impact.
      Are medications necessary?
      Are they over-prescribed?
      Physicians respond to the expectations of the patient
      Offers a clear conclusion to the consultation
    • Most significant is the knowledge of prescriber
      Physicians prescribe more then patients expect!
      When patients expected prescriptions, they were three times more likely to gain prescriptions for new conditions
      When physicians assume that the patient was expecting a prescription, the patient was 10 times more likely to be issued a prescription!
      Cockburn, J & Pit, S (1997)Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations—a questionnaire study. BMJ 1997; 315 : 520
      http://www.bmj.com/content/315/7107/520.full