Transcript Medication Adherence: Talk, Trends and Tips

Medication Adherence
Erin Rank, PharmD Candidate
The Ohio State University College of
Pharmacy
May 23, 2007
Quote for the Day
“Drugs don’t work in patients who don’t
take them.”
- C. Everett Koop, M.D.
Questions for you……
What are some things that may make you
not want to take your medications?
What are the benefits of your
medications?
How do you remember to take your
medications?
Objectives
Definition
WHOs Three Pillars
Facts and Stats
Importance of medication adherence
Predictors of poor adherence
Barriers to adherence
Tips to improve adherence
What is medication adherence?
The extent to which a patient follows a
medication regimen as prescribed by their
doctor
Patient-centered
Mutual understanding between patient and
doctor
Replaced “compliance”
No perfect term
What is medication adherence?
Influenced by many different factors:
Patient
Practices of physician/healthcare team
Insurance/health system
Patient’s social support and environment
What’s the bottom line?
You can only get the full benefit of your
medication if you follow your prescribed
treatment plan
A few notes about medications
Can take weeks to months to work
Skipping “a dose or two” CAN be a
problem
Many side effects subside after awhile
If one med doesn’t work, there are many
others to try
Herbal products CAN interact
World Health Organization’s Three Pillars
of Adherence
Three Pillars:
Patient information
Motivation
Behavioral skills
*Motivation most important as it is key in longterm behavior changes
Adherence Facts
Higher adherence rate in acute vs. chronic
conditions
Chronic diseases hit a low point after 6
months
50% of patients on ADs won’t be taking
them after 3 months
Adherence decreases as # of meds
increases
Adherence Facts
Adherence is hard to measure clinically
Means different things to different people
Rate of adherence can range from 0 to
over 100%
Rates reported ~ 40-75% for chronic
diseases
Adherence Facts
Omitted or delayed doses most common
“White-coat” adherence
Increased dose frequency  poor
adherence
Adherence to medication determined by
dosing frequency
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Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther
2001;23:1296-1310.
What adherence patterns are typical in
chronic disease?
1/6- Take few or no doses, but give good
impression
1/6- Have nearly perfect adherence
1/6- Drug holidays each month or more
1/6- Drug holidays 3-4 times each year
1/6- Miss an occasional dose
1/6- Take almost all doses but have some
timing issues
Why do we care?
Poor adherence associated with increased
death, worsening of disease, and
increased costs to patient and health care
system
Factors that contribute to poor adherence
Treatment of disease without symptoms
Complex treatment plan
Cost
Poor relationship with doctor
Missed appointments
Cognitive/psychological problems
Poor understanding of disease
Factors that contribute to poor adherence
Poor follow-up by physician
Lack of patient “buy-in”
Concern about taking drugs
Limited social support
Substance abuse
Physical problems
Anger about the illness
Side effects
Factors that contribute to poor adherence
COST
SIDE EFFECTS
Cost concerns
Generics
Ask your pharmacist
Talk with your physician to increase
awareness
Assistance for some medications that
insurance plan doesn’t cover
http://www.newstarget.com/021714.html. This site is part of the NewsTarget Network ©2004,2005 All Rights Reserved.
Side effect management
Common undesirable effects:
Nausea
Weight gain
Sexual dysfunction
Drowsiness
Sleep changes
Dry mouth
Blurred vision
Side effect management
Common undesirable effects:
Constipation
Dizziness
Anxiety
Talk with your health care team—many ways to
deal with these issues!
Why do patients report poor adherence?
Biggest problem—forgetfulness
Drugs don’t fit in lifestyle
Chose to miss doses
Incomplete information
Don’t know
Barriers on the provider side
Complex regimens
Discuss benefits/side effects
Cost issues
Consideration of drug and lifestyle needs
Relationship with patient
Barriers on the Health System side
Formularies
Co-payments/cost-share
Provider access
Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497.
Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect on patient
persistence with hypertension medications. Am J Manag Care 2005;11:SP27-SP34.
Zyczynski TM, Coyne KS. Hypertension and current issues in compliance and patient outcomes. Curr
Hypertens Rep 2000;2:510-514.
Interventions to improve adherence
Four main targets:
Patient education
Increased provider access
Improved communication between health care
team and patient
Alterations in dosing schedules
What can you do?
Communication is key!
-Talk to your doctor/health care team
-Know your insurance plan
-Pick the plan that is right for you
-Ask about generics and cheaper
alternatives
What can you do?
Use reminders:
Sticky notes
Beeping alarms
Timers
Pill box (count out doses in advance)
What can you do?
Support system friends, family, healthcare team
Make your regimen fit your lifestyle
Plan ahead for refills/travel/weekends
Write it down!
Journal, planner
Write down when a dose is missed and why
What works and what doesn’t
Remember………
There is a drug and/or regimen that can
work for you!
Questions?
Thanks!
References
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Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497.
Aruffo, S., Grey, S. Think you have a compliance problem? Think again. The Case Manager
2005;16:43-46.
Vlasnik, J.J., Aliotta, S.L., DeLor, B. Evidence-based assesment and intervention strategies to
increase adherence to prescribed medication plans. The Case Manager 2005;16:55-59.
Vlasnik, J.J., Aliotta, S.L., DeLor, B. Medication adherence: factors influencing compliance with
prescribed medication plans. The Case Manager 2005;16:47-51.
About.com: http://aids.about.com/cs/adherence/tp/tenadherence.htm; Accessed May 4, 2007.
©2007 About, Inc., A part of The New York Times Company.
Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect
on patient persistence with hypertension medications. Am J Manag Care 2005;11:SP27-SP34.
Zyczynski TM, Coyne KS. Hypertension and current issues in compliance and patient outcomes.
Curr Hypertens Rep 2000;2:510-514.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens
and medication compliance. Clin Ther 2001;23:1296-1310.