This document discusses patient medication adherence. It defines adherence as taking medication as recommended by a healthcare provider. Adherence is affected by social, economic, healthcare system, condition-related, and patient-related factors. The five main dimensions that determine adherence are social/economic factors, provider-patient/healthcare system factors, condition-related factors, therapy-related factors, and patient-related factors. The role of pharmacists is to improve communication, provide education, simplify treatment regimens, monitor side effects, and involve patients to enhance medication adherence.

1. PATIENT MEDICATION
ADHERENCE
Aswathy N S
Pharm D

2.  Definition
 Factors affecting medication adherence
 Role of pharmacist in improving the adherence.

3. MEDICATION ADHERENCE
 Defined by the World Health Organization as “ the extent to which a persons
behaviour taking medication…corresponds with agreed recommendations from a
health care provider”
 Adherence : Patient participation in treatment as a shared decision- making
process.The patient is under no compulsion to accept a particular treatment.

4. FACTORS AFFECTING MEDICATION ADHERENCE
 Age ang Gender of the patient
 Income
 Education
 Patient intelligence
 Knowledge about the disease
 Illness being treated. Actual seriousness of disease
 Actual efficiency of the treatment
 Marital state
 Number of people in household.
 Therapeutic regimen
 Clinical settings

5. Adherence is a multidimensional phenomenon determined by the interplay of five
sets of factors, termed “dimensions” by the world health organization:
1. Social /economics factors.
2. Provider-patient/health care system factors.
3. Condition-related factors.
4. Therapy-related factors.
5. Patient-related factors

7. SOCIALAND ECONOMICS 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 facilities
 Medication cost
 Elder abuse
 Inability or difficulty accessing pharmacy.
 Cultural and lay beliefs about illness and treatment.

8. HEALTH CARE SYSTEM DIMENSION
 Provider-patient relationship.
 Provider communication skills(contributing to lack of knowledge or
understanding of the treatment regimen).
 Disparity between the health beliefs of the healthcare provider and those of the
patient.
 Lack of positive reinforcement from the healthcare provider.
 Weak capacity of the system to educate patients and provide follow-up.
 Lack of knowledge on adherence and of effective interventions for improving it.

9.  Patient information materials written at too high literacy level.
 High drug cost
 Poor access or missed appointments
 Long wait times
 Lack of continuity of care
 Restricted formularies; changing medications covered on formularies.

10. CONDITION-RELATED DIMENSION
 Chronic conditions
 Lack of symptoms
 Severity of symptoms
 Depression
 Psychotic disorders
 Mental retardation/developmental disability

11. THERAPY-RELATED DIMENSION
 Complexity of medication regimen( number of daily doses ; number of concurrent
medications)
 Treatment requires mastery of certain techniques(injections , inhalers)
 Duration of therapy
 Frequent changes in medication regimen
 Lack of immediate benefit of therapy
 Medications with social stigma attached to use
 Actual or perceived unpleasant side effects.
 Treatment interferes with lifestyle or requires significant behavioural changes.

12. PATIENT-RELATED DIMENSION
 PHYSICAL FACTORS:
 Visual impairment
 Hearing impairment
 Cognitive impairment
 Impaired mobility or dexterity
 Swallowing problems

13.  PSYCHOLOGICAL/BEHAVIORAL FACTORS:
 Knowledge about disease
 Perceived risk/susceptibility to disease
 Understanding reason medication is needed
 Expectations or attitude toward treatment
 Motivation
 Fear of possible adverse effects
 Fear of dependence
 Psychological stress, anxiety, anger
 Alcohol or substance abuse

14. ROLE OF PHARMACISTS IN MEDICATION ADHERENCE
 Be friendly and approachable to the patient
 Improve communication skills
 Take into account the spiritual and psychological needs of the patient
 Improve in patient education
 Encourage the patient to discuss their main concern without interruption or
premature closing.
 Elicit the patient perception of the illness and the associated feelings and
expectations.
 Learning methods of active listening and empathy.

15.  Give clear explanation(regarding disease and drugs)
 Check the patient understanding.
 Simplify the therapeutic regimen.
 Monitor the side effects
 Monitor the beneficial effects.
 Speak the same language of patient.
 Involvement of the patient treatment discussion.

16. THANK YOU