Adherence Flashcards
Define adherence
The extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider
Medication Possession Ratio (MPR)
MPR = Days supplied from refills /days observed
High Adherence Definition
- Taking greater than or equal to 80% of prescribed medications
Other ways to measure adherence
Direct observation
Blood levels of the drug
Pill counts
Patient self-report
Questionnaires / scores
Electronic monitoring
Morisky Scale
1) Have you ever forgotten to take your BP medicine?
(2) Are you sometimes careless in your regards to your medicine?
(3) Do you skip your medicine when you are feeling well?
(4) “When you feel badly due to the medicine, do you skip it?”
1 point for each “YES”
Higher scores increase risk for non-adherence
Accuracy uncertain
Medication Event Monitoring System
- Just one V at the top, missed a dose
- A large black line at top, missed multiple doses
Lots of info, but not used - Expensive
What medications have poor adherence?
- Chronic medications
Non-persistence Adherence
Discontinuation of a medication
Likely the most common cause of low adherence
Non-persistence often occurs within the first few months of starting a drug
not seeing benefit immediately
Poor Execution
Failing to follow dosing instructions
- failing to take enough!
TECHNICALLY – “over-dosing” is an example of non-adherence due to poor execution.
However, non-adherence is not typically used to describe this situation
Primary Non-adherence
Patients never take their prescription to the pharmacy
Why is distinguishing poor adherence important?
Poor adherence may eliminate the benefit of the drug
Consequences of non-adherence
2/3 of all drug-related hospitalizations may be preventable
20% to 30% of life-threatening events may be preventable
Cost of preventable events in Canada estimated at $10 billion per yr
Medication errors?
Over prescribing from perceived ineffectiveness
Duplicate prescribing from transitions of care
Waste of taxpayers money
Reimbursement for drugs that will never take effect
Investing in Drug Costs
Almost 30% of all health care costs in Canada originate from hospitals
Therefore, optimizing the management of chronic diseases in the community setting can help decrease health care costs (if we can prevent expensive hospitalizations like heart attacks etc)
Six categories proposed to organize factors causing non-adherence
Patient Factors –> Knowledge, attitudes, beliefs, literacy, education
Drug Factors –> Side effects, cost, benefits
Disease Factors –> Symptoms, prognosis
System Factors –> Specialist avilability, testing, distance from clinics, organization of care, racism
Socioeconomic factors –> acess, transportation, income, competing priorities in the family
Provider factors –> Communication, Knowledge, trust
Interpretation Warnings
Poor knowledge, low incomes can be reasons for poor adherence
Poor adherence does not equal poor attitude
