This document discusses strategies to improve medication adherence. It defines medication adherence and factors that influence adherence such as social/economic barriers, therapy complexity, and patient beliefs. Methods to measure adherence include direct testing and indirect methods like patient surveys. Strategies to improve adherence involve simplifying prescriptions, educating patients, addressing barriers, and using technology like smart packaging and mobile apps. The document emphasizes the importance of physician-patient collaboration to improve education and empowerment.

1. Medication adherence
PRESENTED BY - ARBEENA SHAKIR
PRESENTED TO - Dr. SAYED EHTASHAMUL HAQUE

2. Table of contents
05
04
02
03
Definition
Factors influencing adherence
behavior
Methods to measure adherence
Strategies to improve medication
adherence
01
Patient referrals to doctors

3. Definition
01

4. Definition of medication adherence
"Medication adherence is defined as the extent to which patients take medication
as prescribed by their doctors.
This involves factors such as getting prescriptions filled, remembering to take
medication on time, and understanding the directions."
"A patient is considered adherent if they take 80% of their prescribed medicine(s).
If patients take less than 80% of their prescribed medication(s), they are
considered nonadherent."
The American Pharmacists Association says medication adherence is "... the
extent to which a patient's behavior (e.g., taking medications with respect to
timing, dosage, and frequency) corresponds with agreed-upon recommendations
from a healthcare provider."

5. Factors influencing adherence behavior
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6. Factors influencing adherence behavior

7. 1. Social/economic factor
Social and economic factors such as poverty or financial stress, transportation
challenges, cultural beliefs, medication costs and inadequate insurance are significant
drivers of medication nonadherence.
2. Therapy related factors
Therapy-related factors like complex therapy regime, taking different medications at
different times of day, frequent changes in medication regime or long duration of
treatment and side effects of medications are also major barriers to adherence.

8. 3. Patient related factors
Patient-related factors like forgetfulness, physical impairments, beliefs about medication and
low health literacy also impact the ability to optimize medication therapy.
Lack of knowledge about the disease and the reasons the medications are needed, lack of
motivation and substance abuse also are associated with poor medication adherence.
4. Condition related factors
Condition-related factors are related to the level of disability (physical, psychological, social
and vocational), rate of progression and severity of disease.
Health care team and system-related factors like lack of training on chronic diseases, poor
communication between the physician and patient regarding the benefits of the medication,
instructions for use and medication side effects can adversely affect medication adherence.

9. Methods to measure adherence
03

10. Direct methods of measurement
Measurement of the level of a drug or its metabolite in blood or urine and detection or
measurement of a biological marker added to the drug formulation, in the blood.
Direct approaches are one of the most accurate methods of measuring adherence but are
expensive.

11. Indirect method
It includes patient questionnaires, patient self reports, pill counts, rates of prescription
refills, assessment of patient’s clinical response, electronic medication monitors,
measurement of physiologic markers, as well as patient diaries.
Each method has its own advantages and disadvantages and no method is
considered as the gold standard.
The simplest way of measuring adherence is from the patient’s self report.
Among the various methods questioning the patient, patient diaries and assessment of
clinical response are all methods that are relatively easy to use, but questioning the
patient can be susceptible to misrepresentation and tends to result in the health care
provider overestimating the patient’s adherence.

12. Strategies to improve medication
adherence
04

13. 1. Level of prescribing
● Introduce a collaborative approach with the patient at the level of prescribing
Whenever possible, involve patients in decision making regarding their medications so that they
have a sense of ownership and they are partners in the treatment plan.
● Simplify medication taking
Use the most possible simplified regimen based on patient characteristics at the first level of
drug use.

14. 2. Communicating with patient
● Explain key information when prescribing/ dispensing a medicine
Address the key information about the drugs (what, why, when, how,
and how long). Inform the common side effects and those that
patient should necessarily know (Patients would be more worried
and lead to non adherence due to side effects that was not
cautioned to them in advance by health care professionals)
● Use medication adherence improving aids
Provide medication calendars or schedules that specify the time to
take medications, drug cards, medication charts or medicine related
information sheets.

15. ● Provide behavioral support
Collaborate with patient to incorporate the medication regimen into his/her daily regimen
(essential in those on complex drug regimens, those having unintentional difficulties in
adherence e.g. elderly)
3.during follow ups
● Schedule appropriate follow up Monitoring the medication adherence should also be a criteria
while scheduling patient follow up
● Assess adherence during consequent follow ups Measure adherence by various methods
which may be dependent on patient as well as drug characteristics. Check the effectiveness
of medication adherence aids used, if any. This should be done by physicians as well as
pharmacists.
● Identify difficulties and barriers related to adherence Address the problems
● Inform the patients accordingly how the problems have been addressed Patient involvement
in decision making is essential in improving medication adherence.

16. 4. Smart options
The rise of new technologies gives the industry powerful new ways to improve medication
adherence.
• Pharmacy incentive programs, such as Walgreens’ Balance Rewards for Healthy Choices,
which provide a set of web, app and text-based programs designed to improve medication
adherence, promote engagement and encourage immunizations.
• In-home telemonitoring that utilizes remote patient monitoring programs to monitor
medication adherence in high risk patients.

17. Innovative medication packaging as offered by PillPack, designed to help patients manage
multiple medications through convenient packaging, modern technology and personalized
service.
• In-home dispensing devices that create reminders and pre- packaged, unit-dose
medications in conjunction with a clinician portal and caregiver app to enable providers to
quickly flag non adherent patients and connect them to a healthcare professional
• Mobile apps that periodically remind patients to take their medications, connect patients
and pharmacists for collaborative care and initiate notifications to a patient’s family if the
person has not taken prescribed medications.

18. “Smart Bottle Caps” that fit standard drugstore containers. The lids register when they’re
removed and log each event in an app to provide real-time oversight by specialty
pharmacists and care coordinators, who can contact the patient if there’s a problem.
“Smart Pills” such as those under the AbilifyMyCite label that incorporate sensors that
track ingestion and send a signal to a wearable patch. The data transfers to a cloud-based
health record to track adherence, with patients deciding who receives their information.

19. Patient referrals to the doctors
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20. WHO scenerio
Strong evidence shows that many patients with chronic illnesses have difficulty adhering to
their recommended medication regimen. Believing that medication nonadherence is the
“fault” of the patient is an uninformed and destructive model that is best abandoned. As
the former Surgeon General C. Everett Koop reminded us,
“Drugs don't work in patients who don't take them.” Thus, physicians must recognize that
poor medication adherence contributes to suboptimal clinical benefits, particularly in light
of the WHO's statement that increasing adherence may have a greater effect on health
than any improvement in specific medical treatments. The multifactorial nature of poor
medication adherence implies that only a sustained, coordinated effort will ensure optimal
medication adherence and realization of the full benefits of current therapies. Current
recognition of the importance of medication adherence has resulted in the development of
many useful Web-based resources.

21. Following are some patient referrals that doctor take into consideration :
● Education of both the patient and physician is important for medication adherence
● The physician should avoid prescribing numerous medications and behavioral
modifications at any one visit because this may overwhelm the patient and induce a
sense of futility
● The more empowered patients feel, the more likely they are to be motivated to
manage their disease and adhere to their medications.
● Involvement of patient in treatment decisions like to ask what time of day they would
prefer to take their medications. One patient may be more likely to adhere to his or
her medications if they were taken in the evening, whereas for another, the morning
may be preferred

22. ● To help combat poor health literacy and its negative effect on medication adherence,
a “shame-free” environment must be created.
● Consideration of patients' economic status is of paramount importance.
● By asking the appropriate questions, physicians can accurately assess which
medications patients are taking and how they are taking them.

23. Thank you……