This document discusses medication adherence, which refers to patients taking medications as prescribed by healthcare providers. Around 125,000 people die each year due to failure to take or improperly take medications. The document explores differences between adherence and compliance, statistics on adherence, factors influencing adherence, and the importance of adherence. It also provides a clinical case study of a patient with low adherence and the barriers and health impacts.

1. MEDICATION ADHERENCE:
DEFINING THE PROBLEM
November 7, 2012
Marquila Ferrell & Sarah Hudson
The University of Toledo

2. Objectives
2
 Define medication adherence
 Explore the differences between medication
adherence and medication compliance
 Identify associated statistics
 Factors that contribute to medication adherence
 Why medication adherence matters?

3. Introduction
3
 125,000 people die a year due to failure to take
medication or taking medications improperly
 Almost 6 out of 10 people are taking at least one
prescription drug
 More than 1 in 3 medicine-related hospital
admissions occur due to people not properly
adhering to their medications
Script Your Future. (2012). National Consumers League.

4. What is Medication Adherence?
4
“The extent to which patients take
medications as prescribed by health care
providers.”
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England journal of medicine, 353(5), 487-
97.

5. Medication Adherence vs. Patient Compliance
5
“Compliance suggests that the patient is passively
following the doctor’s orders and that the treatment
plan is not based on a therapeutic alliance or contract
established between the patient and the physician.”
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England journal of
medicine, 353(5), 487.

6. Medication Non-Adherence
6
 Intentional medication non-adherence
 “Active process whereby the patient chooses
to deviate from the treatment regimen.”
 Unintentional medication non-adherence
 “Passive process in which the patient may be
careless or forgetful about adhering to
treatment regimen.”
Ho, P., Bryson, C., , & Rumsfeld, J. (2009). Medication adherence: Its importance in Cardiovascular Outcomes.
Circulation, 119(23), 3031.

7. Effects of Medication Non-Adherence
7
 Increased hospital readmission
 Increased disease progression and complications
 Increased health care costs
 Decreased quality of life
 Patient death

8. Patient Interviews
8
“Taking my medication helps balance my
life. If I do not take it, I often get sick or
have emotional episodes.”

9. Why Don’t Patients Take Their Medicine?
9
Most Common Reported Reasons
Late Refill
10%
Clinical
Questions
15% Missed Dose
39%
High Cost
16%
Late Renewal
20%
Express Scripts (2012). Retrieved from http://lab.express-scripts.com/wp-
content/uploads/2012/07/Americas_317B_Condition.pdf

10. 5 Dimensions of Medication Adherence
10
Adult Meducation (2006). Overview of Medication Adherence. American Society on Aging and American Society
of Consultant Pharmacists Foundation.

11. Clinical Case Study
11
 Primary source
 48 year old African American male with low
socioeconomic status presenting myocardial infarction
and end-stage renal disease
 Assessment of medication adherence behaviors
 Psychological screening
 Questionnaires
 Post-discharge phone interview
 Electronic pill bottle
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with
myocardial infarction. Frontiers In Psychology, 3:267, 1-3.

12. Post-Discharge Report
12
Measures Details Results
Barriers to adherence Asks whether Rx were filled No barriers self-reported
, and if not, reasons why
not
Morisky scale 8 item self-report 2/8 score
medication adherence scale
Modified CARDIA scale For each medication, self- 7/7 for all medications
reported # of days in
week meds were taken
Electronic pill bottle # of days pill bottle was Aspirin 6/31
opened, divided by total # Statin 3/31
of days monitored B-blocker 2/31
Clopidogrel 0/31
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with
myocardial infarction. Frontiers In Psychology, 3:267, 7.

13. Study Results
13
 Limitations to medication adherence for Mr. P
 Low socioeconomic status
 Lived alone
 Distrust in medications efficacy
 Belief medications being overused
 Outcomes
 Hypertension poorly controlled
 Intermittent chest pain
 Progression of coronary artery disease concern
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with
myocardial infarction. Frontiers In Psychology, 3:267, 4.

14. Summary
14
 What medication adherence is
 Significance of adhering to medications
 Barriers to proper medication adherence
 Pharmacists and MTM services
 Health outcomes and pharmacy administrators

15. Questions
15

16. Resources
16
 Adult Meducation. (2006). Overview of Medication Adherence. American Society on
Aging and American Society of Consultant Pharmacists Foundation. Retrieved from
http://www.adultmeducation.com/OverviewofMedicationAdherence_4.html.
 Express Scripts (2012). Retrieved from http://lab.express-scripts.com/wp-content/uploads/
2012/07/Americas_317B_Condition.pdf
 Ho, P., Bryson, C., , & Rumsfeld, J. (2009). Medication adherence: its importance in
cardiovascular outcomes. Circulation, 119(23), 3028-35. Retrieved from http://
www.ncbi.nlm.nih.gov/pubmed/19528344.
 Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England journal of
medicine, 353(5), 487-97. Retrieved from http://www.nejm.org/doi/full/
10.1056/NEJMra050100.
 Script Your Future. (2012). National Consumers League. Retrieved from http://
scriptyourfuture.org/medication-adherence/.
 Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-
adherence in a patient with myocardial infarction. Frontiers In Psychology, 3:267,
1-7. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411184/.