The Reality of Non-Compliance<br />GreenPharmEdu.org<br />
Non-compliance or Non-adherence<br />Non-complianceoccurs when a patient fails to take medication as directed.<br />Also c...
Non-Compliance<br />Purposeful deviation from prescribed directions<br />Can be conscious or unconscious<br />Under-adhere...
Sorensen et al (2005) <br />Medication management at home: medication risk factor prevalence and inter-relationships <br /...
National Council on Patient Information and Education<br />Half polled said they had forgotten to take a prescribed medici...
Four common manifestations<br />Forgot to take medications as directed<br />Failed to fill a prescription<br />Taking less...
Resisting Medications<br />“Widespread caution about taking medicines highlighted the lay practice of testing medicines, m...
Pound et al<br />“We argue that peoples’ resistance to medicine taking needs to be recognized and that the focus should be...
Medicines non-use in primary care<br />Dislike by patient for using drugs<br />Fear of becoming addicted to non-addictive ...
Costs<br />Prescriptions costs are too high<br />Desire to conserve medications for future use by hording, skipping doses ...
Cover up<br />Some patients continue to reorder medications in order to hide this lack of compliance!<br />Auto-refills an...
Consequences of Poly-pharmacy<br />As number of medications increases, <br />so do non-compliance rates!<br />One in four ...
Brown-bag Medication Review<br />More effective drug usage is effected by awarenessfor both physician and patient.<br />Li...
Asynchronous prescribing<br />Patients with on several prescriptions have refill cycles out of sync.<br />This can lead to...
Prescriber and Rational Prescribing<br />Prescribers role have an impact.<br />Are medications necessary? <br />Are they o...
Most significant is the knowledge of prescriber<br />Physicians prescribe more then patients expect!<br />When patients ex...
Upcoming SlideShare
Loading in...5
×

3.3. The Reality of Non-Compliance

679
-1

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
679
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

3.3. The Reality of Non-Compliance

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

×