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Medication Adherence-DBediako

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Medication Adherence-DBediako

  1. 1. Daniel Bediako, Pharm.D Candidate 2015 Sarah Amering, Pharm.D; BCACP Ruth Fertel/Tulane University Community Health Center September, 2014 Medication Adherence 1
  2. 2. Objectives  Define medication adherence  Identify some benefits of medication adherence  Provide statistics on medication nonadherence  Emphasize the economic burden of med. nonadherence  Explain the five dimensions of medication nonadherence  Suggest practical strategies to improve medication adherence 2
  3. 3. What is Medication Adherence? It refers to the patient’s conformance with the provider’s recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time. Source: WHO 2003 3
  4. 4. Benefits of Medication Adherence  Enhances patient safety  Decreases health care costs  Improves long-term therapies and outcomes  Good investment for tackling chronic conditions 4
  5. 5. Med. Non-adherence Statistics  Patients with psychiatric disabilities are less likely to be compliant  Overall, about 20% to 50% of patients are non-adherent to medical therapy  Nonadherence to medications is estimated to cause 125,000 deaths annually  People with chronic conditions only take about half of their prescribed medications 5
  6. 6. Med. Non-adherence Statistics  Adherence drops with long waiting times at clinics or long time lapses between appointments  1 in 5 patients started on warfarin therapy for atrial fibrillation discontinue therapy within 1 year  Adherence to treatment regimens for high blood pressures is estimated to be between 50% and 70 %  Rates of adherence have not changed much in the last 3 decades, despite WHO and Institute of Medicine (IOM) improvement goals 6
  7. 7. Cost of Medication Non-adherence  Annually, non-adherence costs $2,000 per patient in physician visits  Nonadherence results in an economic burden of $100 to $300 billion per year  Nonadherence accounts for 10% to 25% of hospital and nursing home admissions  The rate of non-adherence is expected to increase as the burden of chronic disease increases  Revenue loss by major pharmaceutical class  Source: Capgemini Group (pls. refer to last sheet) 7
  8. 8. The Five Dimensions Of Non-adherence  Defines adherence as a multidimensional phenomenon determined by the interplay of five sets of factors.  A holistic approach to address improve medication adherence.  These dimensions interact with one another.  Are patients solely responsible for taking their treatments? 8
  9. 9. The Five Dimensions Of Non-Adherence 9
  10. 10. The Five Dimensions Of Non-Adherence  Socio-economic factors  Poverty  Illiteracy  Unemployment  Family dysfunction  High cost of transport  High cost of medication  Low level of education  Poor socioeconomic status  Unstable living conditions  Long distance from treatment centre  Condition-Related factors  Disability level  Follow-up treatment,  Emphasis on adherence  Available effective treatments  Progression /severity of the disease  Co-morbidities (e.g. Depression and drug/alcohol abuse) 10
  11. 11. The Five Dimensions Of Non-Adherence  Therapy-Related factors  Side-effects  Treatment duration  Available medical support  Complex medical regimen  Previous treatment failures  Immediate beneficial effects  Frequent changes in treatment  Patient-Related factors  Forgetfulness  Low motivation  Psychosocial stress  Disbelief in the diagnosis  Low treatment expectations  Low attendance at follow-up  Lack of acceptance of monitoring  Disease symptoms and treatment  Hopelessness and negative feelings 11
  12. 12. The Five Dimensions Of Non-Adherence  Health systems factors  Short consultations  Poor health services  Interventions for improving it  Overworked health care providers  Poor medication distribution systems  Inadequate training for health care providers  Lack of incentives and feedback on performance  Lack of knowledge on adherence and of effective  Weak capacity of the system to educate patients and provide follow-up  Inability to establish community support and self-management capacity 12
  13. 13. Strategies to Improve Med. Adherence  The SIMPLE approach o S – Simplify the regimen o I – Impart knowledge o M– Modify patient beliefs and behavior o P – Provide communication and trust o L – Leave the bias o E – Evaluate adherence 13
  14. 14. S—Simplify the Regimen  Encourage use of adherence aids.  Investigate customized packaging for patients  Adjust timing, frequency, amount, and dosage  Match regimen to patient’s activities of daily living  Consider changing the situation vs. changing the patient  Avoid prescribing medications with special requirements  Recommend taking all medications at the same time of day 14
  15. 15. I—Impart Knowledge  Advise on how to cope with medication costs  Focus on patient-provider shared decision making  Involve patient’s family or caregiver if appropriate  Keep the team informed (physicians, nurses, pharmacists)  Provide all prescription instructions clearly in writing and verbally  Reinforce all discussions often, especially for low-literacy patients  Suggest additional information from Internet for interested patients 15
  16. 16. M—Modify Patient Beliefs and Behavior  Address fears and concerns  Provide rewards for adherence  Empower patients to self-manage their condition  Ask patients about the consequences of not taking their medications  Have patients restate the positive benefits of taking their medications  Ensure that patients understand their risks if they don’t take their medications 16
  17. 17. P—Provide Communication and Trust  Use plain language  Practice active listening  Provide emotional support  Improve interviewing skills  Elicit patient’s input in treatment decisions 17
  18. 18. L—Leave the Bias  Develop patient-centered communication style  Acknowledge biases in medical decision making  Understand health literacy and how it affects outcomes  Address dissonance of patient-provider, race-ethnicity, and language  Examine self-efficacy regarding care of racial, ethnic, and social minority populations 18
  19. 19. E—Evaluating Adherence  Self-report  Ask about adherence behavior at every visit  Periodically review patient’s medication containers, noting renewal dates  Use biochemical tests—measure serum or urine medication levels as needed  Use medication adherence scales— e.g.  Morisky-8 (MMAS-8), Medication Possession Ratio (MPR),  Proportion of Days Covered (PDC) 19
  20. 20. Question  The economic burden of medication non-adherence: who is to blame? 20
  21. 21. Works Cited  Agency for Healthcare Research and Quality (2012). Medication Adherence Interventions: Comparative Effectiveness Closing the Quality Gap: Revisiting the State of the Science  American College of Preventive Medicine http://www.acpm.org/?MedAdherTT_ClinRef (9/07/2014)  Capgemini Consulting (2011) Estimated Annual Pharmaceutical Revenue Loss Due to Medication Non-Adherence  Centers for Disease Control and Prevention. Noon Conference: Medication Adherence. (03/27/2013)  Hugtenburg, J., Timmers, L., Elders, P., Vervloet, M., & van Dijk, L. (2013). Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Preference And Adherence, 7675-682.  WHO (2003). Adherence to Long-Term Therapies Evidence for Action, Geneva, Switzerland 21

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