This document discusses drug adherence, which refers to how well a patient follows their prescribed treatment plan. It defines adherence and differentiates it from compliance. There are multiple dimensions that can impact adherence, including social/economic factors, the healthcare system, a patient's condition or treatment regimen, and individual patient characteristics. Barriers to adherence include polypharmacy (taking many medications), complex dosing schedules, and forgetfulness. Adherence is best measured using tools like medication event monitoring systems or Morisky's Medication Adherence Scale. Improving adherence requires addressing barriers and simplifying treatment plans through measures like combining medications.

1. DRUG
ADHERENCE
BY DR NADIA SHAMS * & DR ASIA ZAMEER**
*PROFESSOR/ HOD RIHS
**PGT FCPS RIHS

3. LEARNING OBJECTIVES
• What is drug adherence
• Difference between adherence and compliance
• Different dimensions and barriers of drug adherence
• What is Polypharmacy ?
• How to measure and improve drug adherence

4. DEFINITION OF DRUG ADHERENCE
“The degree to which the person's behavior corresponds with the
agreed recommendations from a health care provider.”
___________________________________________________
WORLD HEALTH ORGANIZATION

8. DIMENSIONS OF DRUG ADHERENCE
Adherence is a multi
dimentional phenomenon,
dimensions by WHO

9. SOCIAL AND ECONOMIC DIMENSION
• Limited English language proficiency
• Low health literacy
• Lack of family or social support network
• Unstable living conditions; homelessness
• Burdensome schedule
• Limited access to health care facility

10. CAN YOU READ THE NAME OF THIS MEDICINE ?
EVEN I CAN’T

11. CONT - SOCIAL AND ECONOMIC DIMENSION
• Lack of health care insurance
• Inability or difficulty accessing pharmacy
• Medication cost
• Elder abuse

12. • Cultural beliefs
• Superstitions
• Quackery
Have you ever came across such an advertisement ?

13. Or this magical broom
that can treat diabetes
or ischemic heart
disease?

14. HEALTH CARE SYSTEM DIMENSION
1 Provider patient relationship
2 Provider communication skills
3 Disparity between the health beliefs
4 Lack of positive reinforcement

15. CONT.
5. missed appointments
6. Long wait times
7. Covid 19 lockdowns
8. Lack of community care

16. CONDITION RELATED DIMENSION
1 Chronic conditions
2 Improvement of symptoms
3 worsening of symptoms
4 Depression
5 Psychotic disorders
6 Mental retardation or developmental
disability

17. THERAPY RELATED DIMENSIONS
1 Complexity of medication regime
2 Treatment requires mastery of techniques (use of inhalers etc)
3 Duration of therapy
4 Frequent changes in medication

18. PATIENT RELATED DIMENSIONS
• Psychological / Behavioural
• Impaired vision
• Physical morbidity
• Cognitive decline, dementia

20. BARRIERS TO DRUG ADHERANCE
.

25. WHAT IS POLYPHARMACY ???

26. Polypharmacy (PP): the use of five to nine drugs.
No polypharmacy: < 4 drugs (included those taking no medicines)

27. MEASURING MEDICATION ADHERENCE
Medication Event Monitoring System (MEMS)
MOST ACCURATE METHOD
RECORDING OF THE DATE AND TIME WHEN MEDICATION BOTTLE WAS OPENED
THROUGH MICROPROCESSOR TECHNOLOGY

28. .
3 Pill counts
4 Pharmacy data bases /refill rates
5 Blood levels
6 MORISKY’S MEDICATION ADHERANCE SCALE (MMAS)

29. HOW TO IMPROVE
DRUG ADHERANCE
.

33. Use of combination pills /poly pills

38. MMAS-8 QUESTIONS Geriatric
(n=100)
Non-
Geriatric
(n=100)
1. Forgets to take medicines sometimes 58% 45%
2. During last 2 weeks forgot to take medicines
at some days
60% 47%
3. Stops when feels unhealthy after taking 40% 28%
4. Forgets to take medicines while leaves home 52% 40%
5. Took medicines yesterday 85% 79%
6. Stops medicines when feels healthy 32% 23%
7. Feeling hassled about sticking to treatment
plan
75% 81%
8. Difficulty in remembering to take medicines
 Never/rarely (4)
 Once in a while (3)
 Sometimes (2)
 Usually (1)
 All the time (0)
15%
45%
10%
7%
0%
39%
31%
11%
2%
0%

39. RESULTS
• 62% patients were non-adherent
• 40% had poor knowledge of disease
• Associations of non adherence were
• Geriatric age group
• Poor disease knowledge
• Illiteracy
• Visual morbidity
• Polypharmacy
MMAS-8 QUESTIONS Geriatric
(n=100)
Non-
Geriatric
(n=100)
1. Forgets to take medicines sometimes 58% 45%
2. During last 2 weeks forgot to take medicines
at some days
60% 47%
3. Stops when feels unhealthy after taking 40% 28%
4. Forgets to take medicines while leaves home 52% 40%
5. Took medicines yesterday 85% 79%
6. Stops medicines when feels healthy 32% 23%
7. Feeling hassled about sticking to treatment
plan
75% 81%
8. Difficulty in remembering to take medicines
 Never/rarely (4)
 Once in a while (3)
 Sometimes (2)
 Usually (1)
 All the time (0)
15%
45%
10%
7%
0%
39%
31%
11%
2%
0%

40. TAKE HOME MESSAGE - WHICH WILL YOU PREFER?

41. EXPECTATIONS
VS
REALITY