medication adherence erin rank, pharmd candidate the ohio state university college of pharmacy may...
TRANSCRIPT
![Page 1: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/1.jpg)
Medication Adherence
Erin Rank, PharmD CandidateThe Ohio State University College of
PharmacyMay 23, 2007
![Page 2: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/2.jpg)
Quote for the Day
“Drugs don’t work in patients who don’t take them.”
- C. Everett Koop, M.D.
![Page 3: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/3.jpg)
Questions for you……
What are some things that may make you not want to take your medications?
What are the benefits of your medications?
How do you remember to take your medications?
![Page 4: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/4.jpg)
Objectives
DefinitionWHOs Three Pillars Facts and StatsImportance of medication adherencePredictors of poor adherenceBarriers to adherenceTips to improve adherence
![Page 5: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/5.jpg)
What is medication adherence?
The extent to which a patient follows a medication regimen as prescribed by their doctor
Patient-centered Mutual understanding between patient and
doctorReplaced “compliance”No perfect term
![Page 6: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/6.jpg)
What is medication adherence?
Influenced by many different factors:
Patient Practices of physician/healthcare team Insurance/health system Patient’s social support and environment
![Page 7: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/7.jpg)
What’s the bottom line?
You can only get the full benefit of your medication if you follow your prescribed treatment plan
![Page 8: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/8.jpg)
A few notes about medications
Can take weeks to months to workSkipping “a dose or two” CAN be a
problemMany side effects subside after awhileIf one med doesn’t work, there are many
others to tryHerbal products CAN interact
![Page 9: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/9.jpg)
World Health Organization’s Three Pillars of Adherence
Three Pillars: Patient information Motivation Behavioral skills
*Motivation most important as it is key in long-term behavior changes
![Page 10: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/10.jpg)
Adherence Facts
Higher adherence rate in acute vs. chronic conditions
Chronic diseases hit a low point after 6 months
50% of patients on ADs won’t be taking them after 3 months
Adherence decreases as # of meds increases
![Page 11: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/11.jpg)
Adherence Facts
Adherence is hard to measure clinicallyMeans different things to different peopleRate of adherence can range from 0 to
over 100%Rates reported ~ 40-75% for chronic
diseases
![Page 12: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/12.jpg)
Adherence Facts
Omitted or delayed doses most common“White-coat” adherenceIncreased dose frequency poor
adherence
![Page 13: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/13.jpg)
Adherence to medication determined by dosing frequency
Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther
2001;23:1296-1310.
![Page 14: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/14.jpg)
What adherence patterns are typical in chronic disease?
1/6- Take few or no doses, but give good impression
1/6- Have nearly perfect adherence1/6- Drug holidays each month or more1/6- Drug holidays 3-4 times each year1/6- Miss an occasional dose1/6- Take almost all doses but have some
timing issues
![Page 15: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/15.jpg)
Why do we care?
Poor adherence associated with increased death, worsening of disease, and increased costs to patient and health care system
![Page 16: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/16.jpg)
Factors that contribute to poor adherence
Treatment of disease without symptomsComplex treatment planCostPoor relationship with doctorMissed appointmentsCognitive/psychological problemsPoor understanding of disease
![Page 17: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/17.jpg)
Factors that contribute to poor adherence
Poor follow-up by physicianLack of patient “buy-in”Concern about taking drugsLimited social supportSubstance abusePhysical problems Anger about the illnessSide effects
![Page 18: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/18.jpg)
Factors that contribute to poor adherence
COSTSIDE EFFECTS
![Page 19: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/19.jpg)
Cost concerns
GenericsAsk your pharmacistTalk with your physician to increase
awareness Assistance for some medications that
insurance plan doesn’t cover
![Page 20: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/20.jpg)
http://www.newstarget.com/021714.html. This site is part of the NewsTarget Network ©2004,2005 All Rights Reserved.
![Page 21: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/21.jpg)
Side effect management
Common undesirable effects: Nausea Weight gain Sexual dysfunction Drowsiness Sleep changes Dry mouth Blurred vision
![Page 22: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/22.jpg)
Side effect management
Common undesirable effects:
Constipation Dizziness Anxiety
Talk with your health care team—many ways to deal with these issues!
![Page 23: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/23.jpg)
Why do patients report poor adherence?
Biggest problem—forgetfulnessDrugs don’t fit in lifestyleChose to miss dosesIncomplete informationDon’t know
![Page 24: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/24.jpg)
Barriers on the provider side
Complex regimensDiscuss benefits/side effectsCost issuesConsideration of drug and lifestyle needsRelationship with patient
![Page 25: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/25.jpg)
Barriers on the Health System side
FormulariesCo-payments/cost-shareProvider access
![Page 26: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/26.jpg)
Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497.Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect on patient persistence with hypertension medications. Am J Manag Care 2005;11:SP27-SP34. Zyczynski TM, Coyne KS. Hypertension and current issues in compliance and patient outcomes. Curr Hypertens Rep 2000;2:510-514.
![Page 27: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/27.jpg)
Interventions to improve adherence
Four main targets:
Patient education Increased provider access Improved communication between health care
team and patient Alterations in dosing schedules
![Page 28: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/28.jpg)
What can you do?
Communication is key!
-Talk to your doctor/health care team-Know your insurance plan-Pick the plan that is right for you-Ask about generics and cheaper alternatives
![Page 29: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/29.jpg)
What can you do?
Use reminders:
Sticky notes Beeping alarms Timers Pill box (count out doses in advance)
![Page 30: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/30.jpg)
What can you do?
Support system friends, family, health-care team
Make your regimen fit your lifestylePlan ahead for refills/travel/weekendsWrite it down!
Journal, planner Write down when a dose is missed and why What works and what doesn’t
![Page 31: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/31.jpg)
Remember………
There is a drug and/or regimen that can work for you!
![Page 32: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/32.jpg)
Questions?
Thanks!
![Page 33: Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007](https://reader035.vdocuments.us/reader035/viewer/2022062712/56649c6c5503460f9491c94a/html5/thumbnails/33.jpg)
References
Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497. Aruffo, S., Grey, S. Think you have a compliance problem? Think again. The Case Manager
2005;16:43-46. Vlasnik, J.J., Aliotta, S.L., DeLor, B. Evidence-based assesment and intervention strategies to
increase adherence to prescribed medication plans. The Case Manager 2005;16:55-59. Vlasnik, J.J., Aliotta, S.L., DeLor, B. Medication adherence: factors influencing compliance with
prescribed medication plans. The Case Manager 2005;16:47-51. About.com: http://aids.about.com/cs/adherence/tp/tenadherence.htm; Accessed May 4, 2007.
©2007 About, Inc., A part of The New York Times Company. Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect
on patient persistence with hypertension medications. Am J Manag Care 2005;11:SP27-SP34. Zyczynski TM, Coyne KS. Hypertension and current issues in compliance and patient outcomes.
Curr Hypertens Rep 2000;2:510-514. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens
and medication compliance. Clin Ther 2001;23:1296-1310.