5.2 Adherance Flashcards
Medication Adherence
extent to which a persons behavior - taking med, following diet and/or executing lifestyle changes, corresponds with the agreed recommendations from a HCP.
- WHO
Medication Possession Ratio (MPR)
= days supplied from refills / days observed
- Pt recieves 4 dispenses for med. in the last 365 days. Each dispense provides 34 days supply. 34dayx4dispenses = 136/365 = 37%
High adherence
Taking greater than or equal to 80% of prescribed medications
Measuring adherence
- Pt dispense profile
- direct observation
- blood levels of the drug
- pill counts
- patient self report
- questionnaires/scores
- electronic monitoring
Morisky Scale
1 point for each Q answered yes to. Higher score = less adherence
accuracy uncertain
Smart Bottles
- tracks when the bottle has been opened and marks it.
- Can be used with medication event monitoring system (MEMS) -> pharmacist tool to monitor adherence with these smart bottles
—> expensive, not used in practice
Non-persistence
- discontinuation of a medication.
- likely most common cause of low adherence
- often occurs within the first few months of starting a drug
—> Pt thinks that it is not working, s/e, difficult to start a new routine (dosing regimines like QID especially difficult)
Poor execution
- failing to follow dosing instructions
—> failing to take enough - Technically - overdosing is an example of poor execution and non-adherence. Not typically described this way though
Primary non-adherence
-Pt never take their prescription to the pharmacy. Does not obtain their medication
- estimates about the prevalence has been inconsistent
consequences of non-adherence
- 2/3 of all drug related hospitalizations may be preventable
- 20-30% of life-threatening events may be preventable
- cost of preventable events in Canada estimated at $10billion/year
- Medication errors ->over-prescribing b/c of perceived ineffectiveness, duplicate prescribing from transitions of care
- Waste of taxpayer money -> reimbursement for drugs that will never take effect
Investing in drug costs -> why we need to optimize community drug management
-almost 30% of HC cost in Canada originate from hosptials
- Optimizing management of chronic disease in community setting can help decrease HC costs -> prevent expensive hospitalizations
Factors causing non-adherence
- Pt factors -> knowledge, attitudes, education, priorities
- Drug factors -> s/e, cost, benefits
- Disease Factors -> symptoms, prognosis
- System factors -> testing, availability of specialists, distance from clinic, racism
- Socioeconomic factors -> access/transportation, income
- Provider factors -> communication, knowledge, trust
Pt nervous about medication safety
- news reports
- “unnatural chemicals in body”
- long term disease such as cancer when drug taken for years
- concern over number of drugs taken together
- we must have an informed opinion on all of these concerns and more
Framework for adherence
Necessity vs risk
