medical adherence

7/25/2019 Medical Adherence

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CONTENT

No Subtopics Page

1 Introduction to Medical Adherence 2

2 Method In Improving Medical Adherence 3

3 Discussion 9

4 Summary 10

5 e!erences 11

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Introduction

"he #ene!its intended through the use o! medications are not !ully reali$ed #y millions

o! people due to non% adherence that&s largely undetected' Medical adherenceis

de!ined #y the (orld )ealth *rgani$ation +()*, as the e-tent to .hich a person/s

#ehaviour in terms o! taing medications !ollo.ing diets or e-ecuting li!estyle

changes corresponds .ith agreed recommendations !rom the healthcare provider' In

short medical adherence can #e understand as

Adherence = Compliance (patients behaviour coincides with medical or health

advice +medication consumption as instructed, % pills taken) + Persistence

Medical adherence issue gained signi!icance since the last 40 years' )o.ever

research in this area is still lacing .ith limited !indings' omplicating the issue o!

adherence is the !act that the volume o! medications used today in health care .hich

is !ar greater than that o! 40 years ago maing the !undamental issues underlying

adherence more di!!icult to reach' (hilst the pro#lems created #y non%adherence

progress to .orsen .ith more ris and cost'

In the current study medical adherence as proposed #y Morisy .as

operationali$ed to mean the e-tent to .hich patients tae prescri#ed medical

regimens .ithout having the our issues of carelessness, problem in

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rememberin! takin! medications, stop takin! when eelin! better and stop

takin! when eelin! worse due to dru!s side eects.hich !ocus on patient%

related !actor'"he #arrier in achieving medical adherence in a larger scope ho.ever

is generally classi!ied #y ()* into " dimension

1' Socialeconomic !actors

2' "herapy%related !actors

3' atient%related !actors

4' ondition%related !actors

5' )ealth system and healthcare team !actors

Method

1. Evaluation of Medical Adherence

6valuation on ho. .ell a patient is adhering to pharmacotherapy and identi!y ris

!actors that may predispose the individual to non%adherence is crucial #e!ore

e!!ective customised strategies can #e devised to counteract non%adherence'

)o.ever there is still a#sent o! gold standard method to measure medication taing

#ehaviour in .hich #oth direct and indirect methods are temporarily in use to assess

adherence' Direct methods involves directly o#served therapy .hich include #lood%

level monitoring and urine assay !or the measurement o! drug meta#olites or marer

compounds' Indirect methods o! assessing adherence on the other hand include

patient intervie.s pill counts re!ill records and measurement o! health outcomes'

hysicians are encouraged to try more than 1 strategy in detecting adherence in

patient'

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. Strategies in I!proving Medical Adherence

Strategies to improve adherence should target the speci!ic ris !actors and causes

identi!ied during the patient assessment' Adherence strategy may #e used alone or incom#ination #ut should #e tailored to the individual patient' Strategy #ased on !our

Morisy elements and SIM76 intervention are among the strategies availa#le in

improving medical adherence'

.1 Moris"#$s %our Ele!ents Strateg#

Adherence is 8udged #ased on !our main elementsin Morisy Medication Adherence

Scales' "he !our elements includes !orget!ulness carelessness stop taing .hen

!eeling #etter and stop taing .hen !eeling .orse due to drugs/ side e!!ects'

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#$$ &or!etulness

orget!ulness in taing medication can #e corrected #y using adherence tools such

as compartmentali$ed pill#o-es medication calendars post%it note reminders timers

and even high tech taling devices that sound an alarm .hen a dose is missed'

Adherence tool though relia#le have chances o! mal!unction' Manual alertness #y

the patient hence is the most practical' atient alertness can #e instilled #ysetting up

a strategy in .hich medications is designed to #e taen at the same time every day

.hich !it to their daily routine' "he ey here is to set up a cloc.or pattern o! daily

repetition !or taing medication'

orget!ulness can also #e prevented or improved #y involving the !amily mem#ers'amily mem#ers can #e educated .ith regimen as .ell as the techni:ue o!

administration' ;eing the closet person to patient they can help #y reminding the

patient .hile ensuring patient administer medicine in the correct .ay'

#$$# Carelessness

"o prevent carelessness in patient medical provider involved must spea in a

simple and clear manner .hile emphasi$ing the in!ormation necessary !or

compliance early in the communication and then repeat the same in!ormation #oth

orally and in .riting' It is important !or medical provider involved to avoid 8argon and

al.ays #eing alert o! the term used even simple language' "erms common to the

practitioner such as

su#stitution'

A!ter the #rie!ing it is encouraged to assess patient on understanding .here#y

patient .ill #e re:uired to descri#e their regimen as .ell as the techni:ue involved

ver#ally or through .riting' Any misunderstanding spotted should #e highlighted and

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corrected' I! the patient remain con!used a!ter multiple #rie!ing patient/s !amily

mem#ers should #e ased to #e #rie!ed instead'

#$#$' nauthorised ermination o *e!imen hen -mptoms *esides

"he =I/m ured> Syndrome is common among patient .here#y they discontinue the

drug prescri#ed .ithout any medical advice once their symptom remit'

"o cur# this issue patient should #e alerted #y the e!!ect o! sel!%termination o! drug

#y physician or pharmacist upon dispensing o! drug' atient need to #e reminded

that they shouldn/t tae this matter into their o.n hands as there is a standard

procedure in terminating the drug and they shall al.ays re!er to their physician or

pharmacist !or recommendation and advice to prevent adverse e!!ect !rom theiraction' harmacist or physician should o!!er a convenient .ay !or patient to reach

them either #y calling or through mail'

#$#$. nauthorised ermination o *e!imen in Preventin! ide /ect

"o prevent sel!%termination o! regimen #y patient due to side e!!ect it is important !or

physician or pharmacist to #e honest .ith patient a#out side e!!ects' "ry to point out

to patient that every drug has side e!!ects #ut many o! them are short%lived' Discuss

the typical side e!!ects o! the medications that the patient is taing and suggest .ays

!or com#ating them' or e-ample drugs .ith the side e!!ects o! an-iety and

sleeplessness are #est taen in the morning' Sedating medications should #e taen

at #edtime and those lined to nausea are to #e consumed on a !ull stomach'

. SIMP&E Intervention Method

=SIM76> intervention involves a set o! procedure .hich is designed in a .ay that it

includes all !ive ()* dimension maing it one o! the most e!!ective intervention in

com#ating medical non%adherence'

S

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impli!y the egimen


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In simpli!ying a regimen physician should

ad8ust timing !re:uency amount and

dosage o! regimen in a .ay that it is

convenient and match to patient/s activities

o! daily living' "o avoid missed doses

patient should #e recommended to tae all

medications at the same time o! day and to consider the use o! adherence aids 'I!

medication is availa#le in simpler dosage !orm medications .ith special

re:uirements should #e avoided and customi$ed pacaging !or patients could #e

dispensed up to patient convenience'

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"o improve patient adherence physician should !ocus on patient%provider shared decision

maing #y encouraging the patient to have discussions .ith physician nurse and

pharmacist a#out the dou#t they have' It is also important !or physician or pharmacist to

provide clear instructions +.ritten and ver#al, !or all prescriptions' or #etter grip in

patient limit instructions to 3 or 4 ma8or points .hile using simple everyday language'

?se .ritten in!ormation or pamphlets and ver#al education at all encounters and al.ays

attempt to involve !amily and !riends in the discussion .hen appropriate' rovide :uality

.e# sites !or patients .ishing to access health education in!ormation !rom the Internet and

#rie! them on computeri$ed sel!%instruction availa#le online !or comple- chronic

conditions' It is also important !or physician to provide concrete advice !or ho. to cope

.ith medication costs' ein!orce all discussions o!ten especially !or lo.%literacy patients'

mpart @no.ledge

hysician or pharmacist should empo.er patients to sel!%manage their condition #y

asing patients a#out their needs' "o understand their need create an open

dialogue .ith each patient and as a#out his or her e-pectations needs and

e-periences in taing medication' Al.ays ensure patients understand they .ill #e at

ris i! they don/t tae their medication #y re:uesting them to re%descri#e the

conse:uences o! not taing their medication' e.ard system could #e considered to

odi!y atient ;elie!s and ;ehaviour


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7"o prevent !rom #eing #ias in maing decision physician should learn more a#out

lo. health literacy and ho. it a!!ects patient outcomes e-amine sel!%e!!icacy

8

Modi!ying patient #elie!s is only possi#le i! a high level o! patient trust e-ists' A

physician/s communication style is one o! the strongest predictors o! a patient/s trust in

his or her physician' It is hence important !or a physician to ac:uire good

communication sill' A physician .ith good communicating sill has a !e. :ualities

.hich includes good intervie.ing sills practice active listening provide emotional

support provide clear direct and thorough in!ormation elicit patient/s input in

treatment decision%maing as .ell as allo. ade:uate time !or patients to as

:uestions'

rovide ommunication and "rust

eave the ;ias


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regarding care o! ethnically and socially diverse patient populationsand to

acno.ledge #iases in medical decision%maing' It is also important !or physician to

!re:uency revie. their o.n communication style to see i! it is patient%centered'

6"he act o! measuring adherence is crucial in deciding the e!!ective .ays that lead to

#etter patient compliance' "here are 2 .ays in measuring adherence .hich are direct

and indirect methods' Direct method includes directly o#served therapy

measurement o! drug concentration in #lood and measurement o! #iologic marer in

the #ody' *n the counterpart indirect methods include patient sel!%report pill countspharmacy !ill data electronic medication monitoring and assessment o! patient/s

clinical response'

'iscussion

"he (orld )ealth *rgani$ation +()*, states that


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e!!ects not no.ing ho. to tae or use the medication previous unpleasant

e-periences .ith medications comple-ity o! medication regimens cognitive

impairment and !orget!ulness' ersonal !actors including li!estyle culture and #elie!

system is also the main contri#utor to non%adherence in patient as adherence rates

and !actors are al.ays !ound vary in di!!erent places'

ood adherence to.ards medications as .ell as medical advice can help people to

control their health conditions especially those .ith chronic diseases .hich can/t rely

on their impaired natural homeostasis to put them #ac to normal' Despite no.ing

that adhering to prescri#ed medications are necessary to control health conditions

medical non%adherence remains a ma8or pu#lic health pro#lem that that has #een

called an ' Malaysia .hich has hypertension as top iller have

seen .ith e-ceptionally high rates o! non%adherence among patient to.ards anti%hypertensive regimen .here#y !rom studies among BC o! hypertensive patients

.ho .ere receiving treatment only 2E'3 o! their hypertension .as under control'

Medical non%adherence causes treatment !ailure .hich increase disease mor#idity

and mortality' (ith every treatment !ailure additional e-penditure and resource

.astage in the area o! health care is at cost' It is estimated that total health care cost

increase t.o !old .ith non%adherence in taing medications' (ith non%adherence

remain unsolved medical resources .ill continue to #e under%utili$ed including

hospitali$ation o! non%adherent patients .hich increase #urden on health care

.orers' harmacies also lose revenue #ecause patients o!ten !ail to re!ill

prescription medications especially !or chronic disease

Su!!ar#

6!!ective prevention and solution are al.ays lined to ho. highly customised or

designed the steps taen are' 6valuation o! adherence hence play a crucial part in

the e!!ort o! improving patient/s medication adherence as it lead physician or other

healthcare pro!essional involved to the #est patient% customised strategies' Among

the strategies availa#le are Morisy/s !our element #ased !actors .ith corresponding

solution and SIM76 intervention' SIM76 intervention .hich is a set o! procedure

involving all !ive ()* dimension is .idely used !or its high e!!ectiveness in improving

medical adherence in patient' It is al.ays important to note that one%si$e%!it approach

is not the #est option .hen e!!ectiveness is the aspiration'

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(eferences

1' Million )earts +, Improving Medication Adherence Among Patients with

Hypertension: A Tip Sheet for Health Care Professionals,Availa#le

athttp://millionheartshhsgov/files/TipSheet!HCP!MedAdherencepdf+Accessed 15th Fanuary 2015,'

2' hangF'"anG' Isha' +, "eview of the fo#r item Moris$y Medication

Adherence Scale %MMAS&'( and eight item Moris$y Medication Adherence

Scale %MMAS&)(,Availa#le

athttp://wwwahc#mned#/innovations/prod/gro#ps/cop/*p#+/*cop/*innov

/doc#ments/article/cop!article!')-.pdf+Accessed 15th Fanuary 2015,'3' hongS'7'Heo.F' +, Medical Adherence among Hypertensive Patients in

Malaysia,Availa#le

at http://wwwacademiaed#/0.-)0/Medical!Adherence!in!Malaysia +Acce

ssed 15th Fanuary 2015,'

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4' FA' +2000, *ptimi$ing Adherence to harmaceutical are lans Availa#le at

http...'medscape'comvie.article40EE912 +Accessed 15th Fanuary

2015,'5' D +2013, Medication Adherence,Availa#le

athttp://wwwcdcgov/primarycare/materials/medication/docs/medication&

adherence&12ccdpdf+Accessed 15th Fanuary 2015,'E' J)K +, Improving Medication Adherence in 3lder Ad#lts: 4hat Can 4e

5o6,Availa#le at http://wwwchamp&

programorg/static/ImprovingMedAdherence3lderAd#ltslyer!final!-1)Cpdf+

Accessed 15th Fanuary 2015,'C' (orld )ealth *rgani$ation +2003,Adherence to long&therapies: 7vidence for

action,Availa#le

at http://wwwwhoint/chp/$nowledge/p#+lications/adherence!introd#ctionpdf

+Accessed 15th Fanuary 2015,'B' hAMA +2011, Improving Pescription Medicine Adherence is 8ey To 9etter

Health Care,Availa#le

athttp://phrmaorg/sites/defa#lt/files/pdf/Ph"MA!Improving;1Medication;1Adherence!Iss#e;19riefpdf+Accessed 15th Fanuary 2015,'9' 7eeM' +, Improving Medication Adherence ,Availa#le

athttp://wwwtodaysgeriatricmedicinecom/archive/122-p2;shtml+Accessed

15th Fanuary 2015,'10' heung @ )ics F Mc6.en ; ian!arani ' +2012, Strong healthcare

provider&patient relationship improves patient adherence and lowers

healthcare costs: a meta&analysis,Availa#le

athttps://wwwmedcredcom/li+s/pdf/healthcare!portfolios!patient!adherenc

epdf+Accessed 15th Fanuary 2015,'11' )onig#erg orden M (isnie.si A' +2011, S#pporting Patient

Medication Adherence: 7ns#ring Coordination,

medical adherence

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