Introduction: Medication adherence is defined by the World Health Organisation as “The degree to which the person's behaviour corresponds with the agreed recommendations from a health care provider Factor Affecting Non-Adherance:Poor adherence or non-adherence to medical treatment severely compromises patient outcomes and increases patient mortality. Non-adherence is a very common phenomenon in all patients with drug-taking behaviour. The complexity of adherence is the result of an interplay of a range of factors, including patient views and attributes, illness characteristics, social contexts, access, and service issues. Non-adherence: Non-adherence is the failure or refusal to comply with advice and can imply disobedience on the part of patient 5 step Factors: Social/economic and Economic Factors Provider-patient/health care system factors Condition-related factors Therapy-related factors Patient-related factors Behavioural Factors: Life style (smoking, alcohol, coffee use) Psychological and personality factors: anxiety, depression, coping style Biological factors: Gender, age, and genetic predisposition Social and cultural factors: Educational level, living situation, price of medication, policies. Information Factors: Have you received enough information? Satisfaction with the last visit? Awareness factors: Severity of the complaints (Baseline) quality of life, Locus of control about patient adherence: internal and external, stability and control about the cause of the complaints: internal and external, stability and controllability. Stages to Overcome This Barrier

1. MEDICATION
ADHERENCE
BY: LIPANJALI BADHEI

2. INTRODUCTION
“Medication adherence refers to The extent to which patients take medications
as prescribed by physician.”
OR
“Medication adherence is defined by the World Health Organization as “The
degree to which the person's behaviour corresponds with the agreed
recommendations from a health care provider,"

3. FACTORS INFLUENCING NON-ADHERENCE
“Non-adherence is the failure or refusal to comply with advice and can imply disobedience
on the part of patient.”
 Poor adherence or non-adherence to medical treatment severely compromises patient
outcomes and increases patient mortality.
 Non-adherence is a very common phenomenon in all patients with drug taking behaviour.
 Complexity of adherence is the result of an interplay of a range of factors including patient
views and attributes, illness characteristics, social contexts, access and service issues.

4. Adherence is a multidimensional phenomenon determined by the interplay of five sets of factors,
termed "dimensions" by the World Health Organization:
1. Social/economic factors
 Poor socioeconomic status, illiteracy
 Lack of family or Social support
 Lack of Financial resource
 Busy work Schedule
 High Cost of medication
2. Provider-patient/health care system factors
 Relationship od Doctor-patient
 Poor or lack of communication regarding the beneficial effect of taking medication,
instruction, use & side effect
 Poor medication distribution

5. 3. Condition-related factors
 Severity of symptoms ( chronic illness required long term drug administration)
4. Therapy-related factors
 Complexity of medical regimens, duration of treatment
 Lack of immediate benefit of therapy & treatment interferes with lifestyle
5. Patient-related factors.
 Impairments such as Visual, hearing, & cognitive impairments, & Swallowing problems
 Lack of motivation, apprehension about possible adverse side effect
 Stress, anxiety
 Fear of ADR
 Knowledge of disease
 Literacy
 Financial
 Anger

6.  Behavioural Factors:
 Life style (smoking, alcohol, coffee use) Psychological/personality factors: anxiety. depression,
coping style
 Biological factors:
 Gender, Age. genetic predisposition
 Social and cultural factors:
 Educational level, living situation, price of medication, policies.
 Information Factors:
 Received enough information? Satisfaction with last visit?
 Awareness factors:
 Severity of the complaints (Baseline) quality of life,
 Locus of control about patient adherence:
 internal external, stability and control about the case of control about the cause of the
complaints: Internal/external, stability and controllability.
Predisposing factors:

7.  Motivational factors:
 Attitude: Beliefs about medicine about necessity beliefs about medicine about
concerns, harm or overuse.
 Social influence: Normative beliefs, social support, modelling.
 Self-efficacy: Generality, Magnitude, strength
 Demographic and socio economic factors:
 e.g. level of education.
 Marital status Financial resources and cost of care.
 Ethnical and cultural backgrounds.

8. STRATEGIES TO OVERCOME MEDICATION NON ADHERENCE
 Failure to follow a medication regimen is widely recognized as a top reason for treatment failures, serious
adverse reactions and even deaths.
 Pharmacies can accomplish this by guiding their patient's use of their medications. Here is how:
1. Understand each patient's medication-taking behaviour’s:
 Ask patients whether they have trouble filling, taking, or affording their medications
 Create a blame-free environment so patients feel comfortable speaking openly and honestly.
Providers can't help their patients if they don't know there's a problem.
2. Talk about side effects:
 Patients who encounter side effects are less likely to stop taking the medication when they know
about the potential side effects in advance.
 Providers should talk about these side effects and explain how to prevent an adverse drug reaction.
 Ask patients to repeat back the most important points and empower patients to ask questions.

9. 3. Write it down:
 Many patients don't retain verbal instructions, which is why it's important to write information down.
 For example, provide medication calendars, pill cards, schedules, or charts that specify when and how to
take medications.
4. Nurture relationships with patients:
 Patients see and interact with their pharmacist much more often than with their prescriber.
 Pharmacists and pharmacy staff should take at least a few minutes to talk and establish a relationship
with every patient who walks through the door.
 Pharmacists should ask patients how they are feeling, if a new dosage is working better or if they are
experiencing any new side effects, for example.
 All of these questions can start a conversation and allow a patient to open up.
5. Consider the financial burden to the patient:
 If patient can't afford their medications, they may simply stop taking them, or they may ration them.
 To combat this, providers can connect patients with pharmaceutical company based assistance plans,
state-based assistance plans, and pharmacies that provide 30-day supplies of widely prescribed
medications.
 Prescribing lower-cost generic medications is also helpful.

10. 6. Assess health literacy:
 Health literacy, the degree to which individuals are able to obtain, process, and understand basic health
information and services, is a social determinant of health that can greatly affect patient compliance with
medication.
 It is necessary to create health literacy and determine appropriate interventions, so patients understand
when, how, and why to take their medications Providers should not assume that patients understand.
7. Reduce complexity:
 Reducing the complexity of the drug regimen increases the likelihood that patients will follow through
with taking medications correctly.
 Providing combination products, for example. is one way to do this.
 Another is to prescribe medications with once-daily dosing instead multiple doses per day.
8. Follow up with patients:
 Send medication reminders via text, email, or direct mail or during time allotted for chronic care
management services.
 Also, schedule follow-up appointments to discuss medication compliance.
 Make sure they understand why they need to take their medication as prescribed even when they're
symptom-free.

11. 9. Engage community pharmacists:
 Pharmacists are able to not only provide patient education and help patients navigate low-cost or even
free medications-but they can also remind physicians to contact their patients who do not refill their
prescriptions, helping providers address compliance problems before they spiral out of control.
10. Use technology:
 For example, e-pill medication devices (eg, automatic pill dispensers, pillboxes and timers, and alarm
watches) can help improve patient medication compliance.
 A Bluetooth pillbox can even send providers a remote monitoring message each time the patient opens
the pillbox This provides physicians information they can use to detect adherence issues.

12. A systematic approach that could be instituted in improving medication adherence is as follows:
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.)
2. Communicating with the 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.
 Use medication adherence improving aids (Provide medication calendars or schedules that specify the
time to take medications).
 Provide behavioral support(Collaborate with patient to incorporate the medication regimen into his/her
daily regimen).
3. During follow ups:
 Schedule appropriate follow up (Monitoring the medication adherence should also be a criterion while
scheduling patient follow-up).

13. Role of pharmacist:
 Pharmacist often provide verbal education and written individualized information for the patient although
the benefits of these strategies alone are unclear.
 A few studies provide evidence of level II or improved patient medication adherence as a result of patient
education given by pharmacy.
 The information that patients need to know which pharmacist can import includes:
 Name and purpose of the drug.
 When and how to take the medication
 Possible side effects.
 Precautions.
 Interaction with food or other drugs
 Duration of therapy
 Action to take if a dose is missed
 How to tell if the medication is working or not working.
 Pharmacist advise to prescribers on the simplification of drug regimens, providing patients with
medication cards or medication aids such as a dosage and by identifying the predisposing, enabling and
reinforcing factors which may contribute towards medication non-adherence

14. Strategies to improve the pharmacist-patient relationship:
 Be friendly and approachable to the patient.
 Improve communication skills.
 Take into account the spiritual and psychological needs of the patient
 Improving patient education.
 Encourage the patient discuss there main concern without interruption (or) pre mature closing.
 Elicit the patient perception of the illness and associated feelings and expectations.
 Learning methods of active listening and empathy
 Give clear explanation.
 Check the patient understanding.
 Simplify the therapeutic regimen.
 Monitor the side effects.
 Monitor the beneficial effects.
 Speak the same language of patient.
 Involvement of patient treatment discussion.
 Through the patient interviews the pharmacist can assist the patient knowledge of their drug therapy and
usual medication habits.

15. THANK YOY