Patient Medication Adherence

Definition:

Patient Medication adherence is defined as the degree to which a person’s or patient’s behavior corresponds with agreed recommendations from a health care provider.

It refers to the intensity of drug use during the duration of therapy which has greater effects on health than improvements in specified medical therapy.

Treatment > Adherence > Outcomes

Introduction

• Adherence to therapies is the primary determinant of treatment success. Failure to adhere affects not only the patient but also the healthcare system.
• Adherence can also be called compliance or concordance. Here compliance means the extent to which a patient’s behavior matches the prescriber’s advice.
• Medication non-adherence in patients leads to the substantial worsening of disease, death, and increased healthcare costs.
• It can have negative consequences not only on patients but also on pharmacists, physicians, and even medical researchers who are working to establish the value of medication on the target population.
• Adherence rates are typically higher among patients with acute conditions as compared to those with chronic conditions.
• Hence helping people take their medicine appropriately would be a better achievement to avoid a higher risk of
• Severe disease relapses.
• Antibiotic resistance.
• Prevent hospitalizations.
• Prevent lower quality of life.
• Avoid wastage of medication.

Types of Medication Non-Adherences:

The different types of medication non-adherences are as follows:

Primary Non-Adherence:

This is also called non-fulfillment adherence. Here the medical practitioners write the prescription but the medication is never filled or dispensed, since the patients do not take them to the pharmacy and some others fail to pick up the medication from the pharmacy assuming that.

• They have recovered from disease or suffering.
• Having the same medication at home.

Non-Persistence: (Over All Duration)

In this type of non-adherence patients decide to stop a medication after starting it without being advised by a health care professional.

It happens when patients and providers have miscommunication about therapeutic plans like

• Poor administration techniques. Eg: Metered dose inhalations.
• Cost of the medication.

Non – Conforming:

This is the third type and in this type, it includes a variety of ways in which medications are not taken as prescribed. The behavior can range from

• Errors of dosage.
• Errors in the time of administration.
• Pre-matured discontinuation.
• Taking medication more than prescribed.

Factors Affecting Medication Adherence:

Measurement of medication adherence is challenging because adherence is an individual patient behavior.

The following are the factors that are majorly associated with non-compliance which include:

1. Subjective measurements.
2. Objective measurements.
3. Biochemical measurements.

Subjective Measurements:

Non-adherence varies between and within individuals as well as across time, recommended behaviors, and diseases. It also varies with patient age groups (pediatrics and geriatrics) due to their dependence on adult caregivers. They include:

Diseases:

• The nature of the patient’s illness may in some cases or circumstances contribute to non-compliance.
• In patients with psychiatric disorders, schizophrenia (psychotic disorder), hypertension, and hypercholesterolemia which are not often associated with symptoms are more said to be non-compliers.
• It might be anticipated that patients experiencing increased disability will motivate compliance in most cases.

Patient/Health Care Professionals Interaction:

• The patient-physician interaction has been described as the negotiation between two active and equal participants that includes elements of respect, positive attitude, information, translation, feedback, patient response, etc.
• Respect for patients and realistic appraisal of the circumstances of individual patients is essential if therapeutic goals are to be achieved.

Failure To Comprehend the Importance of Therapy:

• The importance of drug therapy and the potential consequences if the medication is not used according to instructions is a major factors.
• Patients should know the exact benefits and expectations with respect to drug therapy.
• If this does not meet these expectations they are more likely to become no complaint.

Poor Understanding of Instructions:

• Patients with low literacy may have difficulty in understanding the instructions which ultimately results in decreased adherence and poor medication management.
• Gender, personality, and cultural factors may also influence adherence compliance rates.

Cost of the Medication:

• Non-compliance may occur with the use of drugs that have relatively low cost or high cost.
• The expense involved has been cited by some patients as a reason for not having prescriptions dispensed at all. Whereas in other cases the medication is taken less frequently than intended or prematurely discontinued.

Asymptomatic Or Symptom Subsides:

It is difficult to convince a patient of the value of drug therapy when the patient has not experienced symptoms prior to the initiation of the therapy.

Objective Measurements:

Multiple Drug Therapy:

• Non-adherence can occur when the medication regimen is complex which could include improper timing of drug administration or administration of the number of medicines at frequent intervals or unusual times during the day.
• Secondly, some elderly patients may experience lapses of memory that make non-compliance more likely.
• Thirdly the similarity in appearance of certain drugs may contribute to confusion which will also lead to non-compliance.

Route of Administration/Frequency of Administrations:

• The route of administration in many times also influences non-compliance towards the medication since they may be at times complicated or dependent.
• The administration frequency also disturbs normal routine work schedules in many cases patients will forget not to be convinced or to be embarrassed to do so.
• The attitude of patients should be anticipated towards their illness.

Duration of Therapy:

• The potential for non-compliance is greater when the treatment period is long.
• Non-compliance should be anticipated in patients with chronic disorders especially anticipated in patients with chronic disorders especially if discontinuation of therapy is not likely to be associated.

Adverse Events:

• The development of unpleasant effects of a drug is a likely deterrent to compliance.
• Nearly 40% of the patients have experienced some form of side effect during medication use, and out of this 40% of people nearly 50% stopped taking the medication as a result of side effects. Examples: Sexual dysfunction, nausea, vomiting, hair loss, headache, etc.

Taste of the Medication:

• This type of non-compliance is seen majorly in children who take especially oral liquids.
• Pharmacists should also have regard towards the size of the medication, wrong route of administration, etc. Example: One patient was suspected death to chewing of diltiazem extended-release capsules.

Biochemical Adherence:

Biochemical measurements obtained by adding a nontoxic marker to medication and detecting its presence in blood or urine or in the measurement of serum drug levels also show the patient’s non-compliance towards the therapy.

Role of Pharmacist in Improving Medication Adherence:

• The effectiveness of the treatment depends on both the efficacy of medication and patient adherence to the therapeutic regimes.
• Patients, health care providers, and health care systems all have a role in improving medication adherence.
• A single method cannot improve medication adherence instead a combination of various adherence techniques should be implemented to improve patient’s adherence to their prescribed treatments.
• The role of the pharmacist in improving medication adherence are:

Development of Treatment Plan:

• The prescription can be used as the organizing instrument of instructions. The more complex the treatment regimen the greater the risk of non-compliance and this must be recognized in the development of a treatment plan.
• The treatment plan should be individualized on the basis of patient needs, and if possible he should also participate in decisions regarding the therapeutic regimen.
• Instructions such as “as directed” or any other directions which create unnecessary confusion should be avoided.
• Treatment medication should not affect the patient’s daily routine works.

Patient Education: Information And Education (Ends In Decision Making)

• Education is the best way to improve compliance. It reduces the communication gap which has serious impacts on public health.
• The main goal is to provide information that the patient is able to understand and use.
• The anticipated benefits should be explained properly.
• Patients should be asked to repeat the instructions to know their level of understanding.

Oral Communication/Counseling the Patient:

• It can be done orally or in written format. It gives the patient an opportunity to raise questions about the therapy such that it increases the rate of compliance.
• Address the key information about the drugs (what, why, when, how, and how long). Inform the common side effects and those that patients necessarily know.

Using Medication Adherence Improving Kits:

• Provide medication calendars or schedules that specify the time to take medications.
• To improve compliance drug cards, medication charts information leaflets, or specific packings such as pill boxes, a unit of use packing, and special containers indicating the time of doses are used.

Providing Behavioral Support:

Collaborate with the patients especially geriatrics and pediatrics to incorporate the medication regimen into his/her daily regimen.

Novel Dosage Systems:

Motivating the patients to use new dosage forms of certain drugs that are longer acting, controlled release can also facilitate compliance. The use of transversal delivery systems has a great impact on developing adherence.

Monitoring Therapy:

The important things involved in these are:

a) Self-Monitoring:

Patients should be apprised of the importance of monitoring their own treatment regimen and responding to the parameters personally.

NOTE: “If your medicine is not working……..it may not be the medicine at all. It could be you”.

b) Pharmacist Monitoring:

• Improved compliance can also be done by pharmacists by follow-ups with telephone, and mailed refill reminders.
• By brown bag programs etc.
• Identify difficulties and barriers related to adherence and assess.
• Checking up on the effectiveness and informing physicians etc.

c) Compliance Packing:

• The manner in which medication is packed also has an influence on patient compliance.
• The use of child-resistant containers for patients having specific diseases like RA; Parkinsonism, and skin allergies has shown a great impact on compliance. Hence this should be changed to improve compliance.

d) Controlled Therapy:

• Hospitalized patients being given the responsibility for self-medication prior to their discharge will also result in better compliance.
• The suggested technique avoids non-compliance since professionals involved can identify problems that create inconvenience can be sorted out and helps also for patients with barriers.

Make sure you also check our other amazing Article on: Patient Counselling