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