Treating HTN HB- Kohlenberg Flashcards
(42 cards)
Approximately (blank) of patients do not take medications as prescribed
50%
T or F
Medications adherence is exclusively the responsibility of the patient
T
T or F
Increasing adherence may have a greater effect on health than improvements in specific medical therapy
T
Statins and antihypertensives have adherence rates below (blank)
(blank) percent do not fill initial statin prescription
50%.
58%
What is primary adherence?
do they fill the prescription
Antihypertensive therapy can reduce risk of stroke by (blank) and MI by (blank). As many as (blank) percent of patient treated for HT are nonadherent to their treatment regimen.
30%
15%
50-80%
WHO says lack of (blank) is the most important cause of failure to achieve BP control
adherence
Within 6 months to 1 year after being prescribed statins, (blank) percent of patients discontinue them.
At 2 years, (blank) percent of patients discontinue them.
25-50%
75%
Which of these drugs has the worst adherence? the Best adherence?
- antihypertensive therapy
- statins
- antiplatelet therapy
- warfarin
warfarin
antihypertensive
from best to worse
Antihypertensive> antiplatelet> statins> warfarin
What is compliance?
Implies that the patient passively follows the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between patient and physician.
What is adherence?
a collaborative model, with health care providers having some responsibility in creating the tx contract
What are some patient related factors that cause poor medication adherence?
Lack of understanding, lack of involvement, poor medical literacy.
In US, 90 million adults have poor health literacy
Health beliefs
Costs, transportation, support (a big problem with mood disorders and CVD)
What age group has the worst adherence?
older people; 20% of pnts over the age of 65 are adherent
(blank) is the greatest risk factor associated with increased incidence of HF in the elderly.
Medication nonadherence
T or F
Women are more nonadherent than men with antihypertensive medications
T
What are physician related factors to non adherence?
- physicians fail to recognize nonadherence (worse estimates when patient is high functioning)
- overly complex drug regiments, ineffective communication
- poor communication amongst physicians (discharge summaries are available at less than 34% of first post discharge visits)
What are health system factors related to non adherence?
Costs
lack of time
fragmented systems
poor coordination
What are strategies to improve medication adherence?
Educated well (patients recall as little as 50% of what is said) Empower patients (motivation and adherence will increase) Motivational Interviewing Avoid complicated regimens
Since not all people are health literate so what should you do to get patients to adhere ?
Make sure they understand, make sure they can read, simplify things, make it a shame free environment, recognize mental illness, tune into economic status
T or F
adherence is improved when a good relationship exists between patient and doctor
T
Patients reporting low ratings of patient-centered communication and trust with their personal clinician had (blank) worse nonadherence rates to medication refills compared with patients reporting high ratings after adjusting for clinical and sociodemographic characteristics.
7% to 16%
What is the cost of having diabetes per month?
$440.45
What are good questions a clinician can ask to assess a patient’s medication adherence?
- I know it must be difficult to take all your medications regularly. How often do you miss taking them?
- Of the medications prescribed to you, which ones are you taking?
- Have you had to stop any of your medications for any reason?
How can you reduce complexity?
- limit pharmacy visits
- adhere to formulary (an official list giving details of medicines that may be prescribed), respect economic realities
- reduce number of pills per day
