Blackburn Lecture Flashcards
What is the official definition of medication adherence?
the extent to which a persons behaviour-taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider
What is the medication possession ratio (MPR)?
days supplied from refills/days observed
What is the definition of high adherence?
taking >80% of prescribed medications
-arbitrary but most people use it
-might differ for some disease states such as HIV
What are some other ways to measure adherence?
direct observation
blood levels of the drug
pill counts
patient self-report
questionnaires/scores
electronic monitoring
What are the questions on the Morisky Scale?
have your every forgotten to take your medicine?
are you sometimes careless in your regards to your medicine?
do you skip your medicine when you are feeling well?
when you feel badly due to the medicine, do you skip it?
How does the Morisky Scale scoring work?
1 point for each yes to a question
=higher scores increase risk for non-adherence
What are the patterns of non-adherence?
non-persistence
poor execution
primary non-adherence
Explain non-persistence.
discontinuation of a medication
likely the most common cause of low adherence
occurs within the first few months of starting a drug
many reasons
-patient thinks its not working, side effects, hard to start a new
routine, some people really feel it when they take pills QD
Explain poor execution.
failing to follow dosing instructions
failing to take enough
they havent quit, they just dont take enough
True or false: over-dosing is an example of non-adherence due to poor execution
true
Explain primary non-adherence.
patients never take their prescription to the pharmacy
estimates of prevalence has been inconsistent
True or false: non-adherence has no change in the benefit of a drug
false
poor adherence may eliminate the benefit of the drug
What are the 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 death in Canada is ~10 billion $/year
over prescribing from perceived ineffectiveness
duplicate prescribing from transitions of care
waste of taxpayers money
Why is optimizing the management of chronic diseases important in the community setting?
it can help decrease health care costs
What are the categories proposed to organize factors causing non-adherence?
patient factors
provider factors
drug factors
disease factors
socioeconomic factors
system factors
disease factors
