Adherence & compliance to a prescribed medical

treatment

Adherence to medication regimens has been monitored since the time of Hippocrates, when the effects of various potions were recorded with notations of whether the patient had taken them or not.

DefinitionsAdherence to a medication

regimen= the extent to which patients

take medications as prescribedby their health care providers.

The word adherence ispreferred by many health careproviders

Definitions Compliance suggests that the

patient is passively following thedoctors orders and that thetreatment plan is not based on atherapeutic alliance or contractestablished between the patientand the physician.

as the percentage of the prescribed doses of the medication actually taken by the patient over a specified period.

as dose taking (taking the prescribed number of pills each day)

as the timing of doses (taking pills within a prescribed period).

also for non-pharmacological treatment

Definitions

Methods of measuring adherence

Methods of measuring adherence

Characteristics of adherence rates

are typically higher among patients with acute conditions, as compared with those with chronic conditions;

disappointingly low among patients with chronic conditions, dropping most dramatically after the first six months of therapy.

LOW ADHERENCE is a growing concernmajor public health problem that

imposes a considerable financial burden upon modern health care systems

a major impact on clinical outcome

MAJOR PREDICTORS OF POOR ADHERENCE TO MEDICATION

Presence of psychological problems, particularly depression

Presence of cognitive impairment

Treatment of asymptomatic disease

Inadequate follow-up or discharge planning

Side effects of medication

MAJOR PREDICTORS OF POOR ADHERENCE TO MEDICATION

Patients lack of belief in benefit of treatment

Patients lack of insight into the illness

Poor providerpatient relationship

Presence of barriers to care or medications

Missed appointments

Complexity of treatment

Cost of medication, copayment, or both

Barriers to adherence

6 GENERAL PATTERNS OF TAKING MEDICATION FOR CHRONIC ILLNESSES

1/6 come close to perfect adherence to a regimen

1/6 take nearly all doses, but with some timing irregularity

1/6 miss an occasional single days dose and have some timing inconsistency

1/6 one sixth take drug holidays three to four times a year, with occasional omissions of doses

1/6 have a drug holiday monthly or more often, with frequent omissions of doses

1/6 take few or no doses while giving the impression of good adherence.

Patients commonly improve their medication-taking behavior in the 5 days before and after an appointment with the doctor, as compared with 30 days after, in a phenomenon known as white-coat adherence.

STRATEGIES FOR IMPROVING ADHERENCE TO A MEDICATION REGIMEN

Identify poor adherence Look for markers of non-adherence: missed

appointments, (no-shows), lack of response to medication, missed refills

Ask about barriers to adherence without being confrontational

Emphasize the value of the regimen and the effect of adherence

Elicit patients feelings about his or her ability to follow the regimen, and if necessary, design supports to promote adherence

Provide simple, clear instructions and simplify the regimen as much as possible

STRATEGIES FOR IMPROVING ADHERENCE TO A MEDICATION REGIMEN

Encourage the use of a medication-taking system

Listen to the patient, and customize the regimen in accordance with the patients wishes

Obtain the help from family members, friends, and community services when needed

Reinforce desirable behavior and results when appropriate

STRATEGIES FOR IMPROVING ADHERENCE TO A MEDICATION REGIMEN

Consider more forgiving medications when adherence appears unlikely

Medications with long half-lives!!! Depot (extended-release) medications!!! Transdermal patches!!! New dosage forms with topical administration

in dentistry (fibers, gels, microspheres, periochips)

STRATEGIES FOR IMPROVING ADHERENCE TO A MEDICATION REGIMEN

New technologies may be needed to help patients who have the most difficulty meeting the goals of a regimen: reminders through cell phones personal digital assistants and pillboxes with paging systems

!!!!!!!!!!!!!!Enhancing communication between the physician and the patient is a key and effective strategy in boosting the patients ability to follow a medication regimen !!!

PHARMACOGENOMICS

AmpliChip CYP450(Hoffmann-LaRoche, 2003)

CYP2D6 and CYP2C19genetic polymorphism identification (5-10% of population)

REFERENCESForeman KF, Stockl KM, Le LB, Fisk E, Shah SM, Lew HC, Solow BK, Curtis BS. Impact of a Text Messaging P ilot Program on Patient Medication Adherence. ClinTher. 2012 Osterberg L, Blaschke T., Adherence to medication. N Engl J Med. 2005; 353(5):487-97.Petry NM. Contingency management: what it is and why psychiatrists should want to use it. Psychiatrist. 2011 May;35(5):161-163. van Onzenoort HA, Neef C, Verberk WW, van Iperen HP, de LeeuwPW, van der Kuy PH. Determining the feasibility of objectiveadherence measurement w ith blister packaging smart technology. AmJ Health Syst Pharm. 2012 May 15;69(10):872-9.Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review . J Clin Pharm Ther. 2001 Oct;26(5):331-42.

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