Medication Adherence
which factor is the following? include delivery of care and the effect of a "toxic" environment on healthy lifestyles and its effect on adherence to disease management.
Health care related factors
what is the the following term? Patient's passive following of provider's orders
compliance
t/f Adherence means that the patient will follow the directions from the prescriber because he/she wants to do so
true
t/f According to the largest meta-analysis of medication adherence rates to date, there are more than 200 variables which affect adherence to medication.
true
t/f Active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result.
true
t/f Adherence also means that the patient's behavior will coincide with the therapy plan.
true
t/f Adherence is cluster of behaviors that is Simultaneously affected by multiple factors
true
t/f Although demographic characteristics are poorly associated with medication adherence, there is an increasing interest in patient perception and medication adherence.
true
t/f An example of direct measures is : Therapeutic drug monitoring (TDM) of medications with narrow therapeutic window; vancomycin, gentamycin, or antiepileptic medication.
true
t/f Another drawback is that opening the bottle/blister/eye drop even at the appropriate time does not mean that the patient has actually taken the medication.
true
t/f Direct measurement of drug concentration, drug metabolites, or drug markers, in the patient's body fluids - Objective - Variations in metabolism - White coat adherence (just before scheduled appointment) - Expensive
true
t/f Direct observed therapy (DOT) -Most accurate - Impractical for routine use
true
t/f High adherence to antihypertensive medication is associated with higher odds of blood pressure control
true
t/f Interventions Should be Patients Centered
true
t/f Morisky Adherence Questionnaire has three levels of adherence considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); 8 (high).
true
t/f NICE defines adherence as 'the extent to which the patient's behavior matches agreed recommendations from the prescriber with emphasis on the patient's freedom to decide whether to adhere to the prescriber's recommendations and that failure to do so should not be a reason to blame the patient'.
true
t/f No particular method is considered the gold standard
true
t/f Patient adherence means that the patient has a recognized right to choose his/her therapy
true
t/f Pill counts and similar technologies are limited with other dosage forms such as liquids, injections and suppositories.
true
t/f Simple dosing (one pill, once daily) helps to maximize adherence
true
t/f The extent to which a person's behavior—taking medication, following a diet, or making healthy lifestyle changes— corresponds with agreed-upon recommendations from a health-care provider
true
t/f The meta-analysis of 569 studies, published from 1948 to 1998, found that the influence of these factors on medication adherence was variable.
true
t/f There are many methods available for measuring adherence that assess patient adherence in both research and clinical practice. Each method has advantages and disadvantages
true
t/f non-adherence is costly
true
t/f nonadherance is not benign can lead to clinical consequences. Adherence = good clinical outcomes Non-adherence = poor clinical outcomes
true
t/f the following are considered predictors of poor adherence to medication - Presence of psychological problems - Presence of cognitive impairment - Treatment of asymptomatic disease - Inadequate follow-up or discharge planning - Side effects of medication - Patient's lack of belief in benefit of treatment - Patient's lack of insight into the illness - Poor provider-patient relationship - Presence of barriers to care or medications -Missed appointments - Complexity of treatment - Cost of medication, copayment (selective coverage of insurance), or both
true
t/f A 10% increase in nonadherence to metformin and statins was associated with an increase of 0.14% in HbA1c and an increase of 4.9 mg/dl in LDL cholesterol levels
true (lead to negative outcome)
A third drawback is that it does not give information about -------- for non-adherence.
reasons
Methods that can be used to improve adherence can be grouped in six categories that can be remembered by the mnemonic ------------
"SIMPLE" S— Simplify the regimen I— Impart knowledge M—Modify patient beliefs and behavior P —Provide communication and trust L —Leave the bias E —Evaluate adherence
What may providers do to overcome these challenges [3]
- Communication is key - Measure medication adherence - Effective interventions to improve adherence
medication adherence scales—for example:
- Morisky-8 (MMAS-8) - Morisky-4 (MMAS-4, also known as the Medication Adherence Questionnaire or MAQ) - Medication Possession Ratio (MPR) - Proportion of Days Covered (PDC)
which factor is the following? or interpersonal factors include relationship between patients and providers and/or social support.
social factor
Example of Assessment of the patient's clinical response and measurement of physiologic markers[indirect measure]
- measurement of blood glucose in diabetics (fasting, postprandial) - measurement of blood glycosylated hemoglobin (HbA1c) - measurement of blood hemoglobin and iron levels in anemic patients (Hgb, Fe, MCV, RBC) - Measurement of cholesterol levels in patients with dyslipidemias - Measurement of blood pressure for hypertensive patients - Occurrence of vertigo, or headaches, diarrhea episodes
Dimensions of Non Adherence (5)
1. Health-care system/team factors 2. Patient- related factors 3. Therapy- related factor (pharmacist focus here) 4. Condition- related factors 5. Social and economic factors
A review of the research priorities to understand barriers to medication adherence was conducted. The review identified six key areas:
1. Measuring adherence 2. Factors affecting adherence 3. Measuring the impact of non-adherence on health and cost 4. Improving adherence research (interventions) 5. Behavior of payers and providers 6. Provider training and coordination of care
Patients taking medication on a schedule of 4 times daily achieved average adherence rates of about ------
50%
which factor is the following? factors include the disease and its management-related factors such as its duration or the complexity of treatment regimen.
Condition and therapy-related
The following relate to which factors ? - Complexity of medication - Frequent changes in regimen - Treatment requiring mastery of certain techniques - Unpleasant side effects - Duration of therapy - Lack of immediate benefit of therapy - Medications with social stigma
Condition- and therapy-related
Which type of measure is the following? - measurement of metabolites of the medication (in blood or urine), - measurement of drug concentration in the patient's body fluids
Direct
which type of measuring medication adherence is the following? - Direct observation - Measurement of medication concentration in body fluids
Direct
Which type of measure is the following? Measurement of the specific biologic marker (added to the formulation of medication) in blood or urine
Direct Measure
Which type of measure is the following? observing the patient taking the medication,
Direct Measure
what is the term? Directly observing the patient taking the medication, such as in tuberculosis direct observation therapy strategy
Direct observed therapy (DOT)
Which method of improving adherence is the following? - Self-report AND ask about adherence behavior at every visit - Periodically review patient's medication containers, noting renewal dates - Use biochemical tests—measure serum or urine medication levels as needed - Use tests to assess physiological outcomes - Use medication adherence scales—for example:
E-Evaluating Adherence
The following relate to which factors ? - Health insurance - Medication cost
Economic
Which type of indirect measure is the following? - Precise and results are easily quantified - Tracks patterns of taking medication - Expensive; specialised apparatus required - Requires return visits and downloading data from medication vials
Electronic medication monitors
which health case factor is the following? -Stress of health-care visits - Discomfort in asking providers questions
Health-care Team
which health case factor is the following? -Access to care -Continuity of care -Patient education material not written in plain language
Health-care system
which type of measuring medication adherence is the following? - Measurement of physiologic markers - Self reports - Pill count
Indirect
Which type of measure is the following? - Patient questionnaires, patient self-reports - Pill counts - Pharmacy records - Electronic medication monitors - Patient diaries - Assessment of the patient's clinical response - Measurement of physiologic markers (mmhm,Ldl) - When the patient is a child or a cognitively impaired adult, questionnaire for caregiver
Indirect Measures
which measure is the following? Are an intrusive method (privacy concerns)
Indirect [pill count and electric medication monitoring]
Which method of improving adherence is the following? - Focus on patient-provider shared decision making - Keep the team informed (physicians, nurses, and pharmacists) - Involve patient's family or caregiver if appropriate - Advise on how to cope with medication costs - Provide all prescription instructions clearly in writing and verbally - Suggest additional information from Internet if patients are interested - Reinforce all discussions often, especially for low-literacy patients
I— Impart knowledge
Which method of improving adherence is the following? - Understand health literacy and how it affects outcomes - Examine self-efficacy regarding care of racial, ethnic, and social minority populations - Develop patient-centered communication style - Acknowledge biases in medical decision making - Address dissonance (lack of harmony) of patient-provider, race- ethnicity, and language issues
L-Leave the Bias
which factor is the following? such as the number, frequency, duration and complexity of the regimen and increasing psychiatric symptoms were found to be negatively associated with medication adherence. However, these associations are not always consistent
Medication -related factors
what is the the following term? The patient's conformance with the provider's recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time
Medication Adherence
the following medication adherence scales belong to which therapeutic area ? BMQ = Brief Medication Questionnaire MARS = Medication Adherence Rating Scale
Mental Health
Which method of improving adherence is the following? - Empower patients to self-manage their condition - Ensure that patients understand their risks if they don't take their medications - Ask patients about the consequences of not taking their medications - Have patients restate the positive benefits of taking their medications - Address fears and concerns - Provide rewards for adherence
M—Modify patient beliefs and behavior
Which method of improving adherence is the following? - Improve interviewing skills - Practice active listening - Provide emotional support - Use plain language - Elicit patient's input in treatment decisions
P-Provide Communication and Trust
Which type of indirect measure is the following? - Objective; easy to obtain data - Prescription refill is not equivalent to ingestion of medication - Does not account for taking the medication in the correct way at the correct times - Requires a closed pharmacy system - Medication possession ratio (MPR), proportion of days covered (PDC)
Pharmacy records
Which type of indirect measure is the following? - Objective - Quantifiable, and easy to perform - Widely used - Data easily altered by the patient (e.g., pill dumping, pill sharing) - Timing of doses is unknown - Overestimates adherence - Time consuming - Cut-off 80% (HTN) vs. (HIV).
Pill count
The following relate to which factors ? - Communication skills - Knowledge of health literacy issues - Lack of empathy - Lack of positive reinforcement - Number of comorbid conditions - Number of medications needed per day - Types or components of medication - Amount of prescribed medications or duration of prescription
Provider factors
Example of Adherence aides
Reminder Chart: as the number of prescriptions for a patient increases the more difficult it can become to track of Pill Card Educational Videos Pill Organizer Digital Dispenser Timer Mobile App.
Which type of indirect measure is the following? - Simple, inexpensive - the most useful method in the clinical setting - Widely used, general or specific - Susceptible to error with increases in time between visits - Inaccurate, poor patient recall - Results are easily distorted by the patient - Overestimates adherence [disadvatage] - Morisky questionnaire
Self report and patient questionnaires
The following relate to which factors ? -Low literacy -Inability to access or difficulty accessing pharmacy -Lack of family or social support -Unstable living conditions
Social
Which method of improving adherence is the following? - Adjust timing, frequency, amount, and dosage - Match regimen to patient's activities of daily living - Recommend taking all medications at the same time of day - Tailor prescribing medications with extra requirements for special groups of patients - Investigate customized packaging for patients - Encourage use of adherence aids - Consider changing the situation vs. changing the patient
S— Simplify the regimen
the following medication adherence scales belong to which therapeutic area ? BMQ = Brief Medication Questionnaire {DM} MAQ = Medication Adherence Questionnaire (also known as the Morisky-4 or MMAS-4 scale) SEAMS = Self-Efficacy for Appropriate Medication Use Scale Hill-bone compliance scale
metabolic disorders : HTN,DM, dyslipidemia
The following relate to which factors ? - Physical -Psychological -Patient's belief or understanding -Patient's forgetfulness or carelessness -Stressful life events -Lack of immediate benefit of therapy
patient related factors
which factor is the following? include patient beliefs, knowledge, attitudes, perceptions and expectations in addition to their demographic factors
patient related factors
what is the the following term? Duration of time patient takes medication, from initiation to discontinuation of therapy
persistance
Adherence rates are typically higher among patients with -------- conditions, as compared with those with chronic conditions (e.g. painful otitis media versus hypertension )
acute
Health-care Factors is devided into 2 :
health care system factors health care team
Adherence is --------- proportional to frequency of dose
inversely the more pills(frequent dosing) the less the adherence
Persistence among patients with chronic conditions is disappointingly ------, dropping most dramatically after the ----------- of therapy
low first six months
