Adherence in elderly
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The document discusses medication adherence in the elderly. It describes a case of a 68-year-old man hospitalized for depression who was admitted to the ICU due to suspected digoxin intoxication from non-adherence. The document then summarizes research showing that medication non-adherence is a major driver of increased healthcare costs and hospital admissions. It discusses the three phases of adherence - initiation, execution, and persistence - and challenges in measuring execution.
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![Case ,[object Object],[object Object],digoxin: 0.25 mg od, acenocoumarol nortriptyline 25 mg qid, sotalol 40 mg bid amiodarone 200 mg od, enalapril 10 mg od furosemide 40 mg bid, oxazepam 10 mg tid methotrexate 7.5 mg/week, olanzapine 2.5 mg od](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Adverse Drug Reactions
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causality-methods_2018
This document discusses causality assessment of adverse drug reactions (ADRs). It provides an overview of two causality models: the WHO model and Naranjo algorithm. It also distinguishes between intrinsic and extrinsic factors that can be considered when evaluating the causal relationship between a drug and an ADR. An example case report is presented and analyzed using elements of causality assessment like dechallenge, rechallenge, and background information from published literature and product information. The learning objectives are to understand how to apply the two causality models and evaluate factors that play a role in ADR causality assessment.
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Adherence in elderly
- 1. Drug exposure and adherence in the elderly March 16 th 2010 Dr. E.R. Heerdink
- 4. Source: Manhattan Research 2004 data Disease Prevalence Reported rate of non-compliance
- 7. Meijer et al Br J Psychiatry 2001
- 16. Infobesity
- 17. Review of statin adherence studies
- 20. initiation discontinuation EXECUTION of the drug regimen Three phases in adherence: Persistence (days) dichotomous dichotomous continuous
- 23. Characteristics of non-starters Van Geffen et al Br J Gen Pract (2009) OR * 95% CI Non-specific indication 2.67 1.82-3.91 Non-western immigrants 4.80 2.05-11.3 >60 years of age 1.81 1.18-2.78 Precollege education level 1.40 0.83-2.36 Poor/moderate self-rated health 1.11 0.76-1.63 Paroxetine 0.78 0.53-1.13
- 24. Reasons for not starting therapy 57 patients with a single prescription 17 non-starters (29,8%) Fear of side effects (8) Aversion towards medication use (3) Pregnancy (2) Feeling better (2) Fear of addiction (1) Practical reasons (1) 40 (70,2%) stopped within 14 days Side effect (25) Aversion towards medication use (7) Feeling better (6) Medication ineffective (1) disagree with diagnosis (1) Ann Pharmacother 2008; 42:218-25
- 25. initiation discontinuation EXECUTION of the drug regimen Three phases in adherence: Persistence (days) dichotomous dichotomous continuous
- 29. time Adherence rate = 80% time Adherence rate = 80%
- 30. Returned medications 4.8 % of all prescriptions are returned to the pharmacy 2 weeks 51 pharmacies Prescriptions Different drugs Dosing units 6,217 9,879 375,859
- 32. Perfect refill patterns perfect adherence Erratic refill patterns non-adherence
- 34. Wijk BLG van, Klungel OH, Heerdink ER, Boer A de Initial non-compliance with antihypertensive monotherapy is followed by complete discontinuation of antihypertensive therapy “ Poor refill compliance in first 90 days determines persistence” Pharmacoepidemiology and Drug Safety (2008)
- 35. time Discontinuation is often preceded by a period of dwindling execution
- 37. Vrijens/Urquhart Basic Clin Pharmacol Toxicol 2005
- 39. initiation discontinuation EXECUTION of the drug regimen Three phases in adherence: Persistence (days) dichotomous dichotomous continuous
- 40. Beyond databases
- 41. Accepting Ambivalent Indifferent Skeptical Necessity Concerns High High Low Low Menckeberg et al 2008
- 42. Medication adherence is an important problem, especially in the elderly Initiation. Execution. Persistence Databases are great to assess persistence. Execution, not so much.
- 43. email: e.r.heerdink@uu.nl slides: slideshare.net/robheerdink twitter: @robheerdink
Editor's Notes
- National Pharmaceutical Counsel