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 patients conformance with the providers 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. SSimplify the Regimen Encourage use of adherence aids. Investigate customized packaging for patients Adjust timing, frequency, amount, and dosage Match regimen to patients 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. IImpart Knowledge Advise on how to cope with medication costs Focus on patient-provider shared decision making Involve patients 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. MModify 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 dont take their medications 16
17. 17. PProvide Communication and Trust Use plain language Practice active listening Provide emotional support Improve interviewing skills Elicit patients input in treatment decisions 17
18. 18. LLeave 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. EEvaluating Adherence Self-report Ask about adherence behavior at every visit Periodically review patients medication containers, noting renewal dates Use biochemical testsmeasure 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