Medication Adherence

the extent to which a patient takes his/her medications as prescribed

compliance

what is the number one reason for failed outcomes?

poor adherence

what are some indirect methods of measuring adherence?

rates of prescription fills, self reports, questionnaires, assessment of clinical response, or electronic medication monitors

describes the length of time a patient takes medications as directed

persistence

what are some questions you can ask a patient to measure adherence?

Why are you taking this medication? How are you taking this medication? What side effects are you experiencing? How do you feel about the medications you take?

ability and willingness of a patient to adhere to a treatment plan agreed upon by the patient and health care professional

adherence

how do you measure adherence?

direct methods, indirect methods, or just by talking to the patient

what are some direct methods of measuring adherence?

directly observe, blood level of med or metabolite, or blood level of biologic marker

what are some strategies to improve adherence?

education, get patients involved, help patient remember, address financial issues, adjust medication regimen, dosing schedule, decrease pill burden, and change to more forgiving medications

what are the effects of non-adherence?

for patients: disease progression and complications, reduced functional abilities, decreased quality of life, and increased morbidity and mortality. For public health: increase in LTC admissions, cost of avoidable hospitalizations, increased physicians' visits, and decreased productivity

what are some reasons for improving adherence?

improved adherence means improved patient outcomes, decreased cost for patients and health system, and shift in reimbursement infrastructure

what are some patient related barriers to patient adherence?

lifestyle, low health literacy, diagnosis, affordability issues, or poor understanding of disease state, treatment regimen, benefits of therapy, or side effects

what are some health care provider/system relatec barriers to adherence?

poor provider-patient relationship, prescribed regimen too complex, cost of medications, lack of synchronization of refills, uncoordinated medical care, and busy healthcare settings