Transcript Magnitude of the Problem

Medication Adherence
• The following module is designed as a basic
overview of medication adherence for providers
of healthcare, particularly those in a patientcentered medical home.
• At the end of this module, the reader should be
able to:
– Define “adherence”
– Name 3 factors which affect adherence to medical
advice
– Outline 3 practical tips to improve adherence to
treatment regimens
Magnitude of the Problem
• “Increasing the effectiveness of adherence
interventions may have a far greater impact
on the health of the population than any
improvement in specific medical treatments”
Haynes RB. Interventions for helping patients to follow prescriptions for medications.
Cochrane Database of Systematic Reviews, 2001, Issue 1.
World Health Organization has an action plan
Adherence
• Adherence -“the extent to which a patient acts
in accordance with the prescribed interval and
dose of a dosing regimen”
• 70% of ambulatory visits involve medications
• Crosses all demographic and diagnostic groups
Magnitude of the Problem
• In developed countries, adherence to longterm therapies in the general population is
around 50% and is much lower in developing
countries.
• Noncommunicable diseases,mental health
disorders,HIV/AIDS and tuberculosis, combined
represented 54% of the burden of all illness
worldwide in 2001 and will exceed 65% of the
global burden of disease in 2020
WHO: Adherence to long-term therapies: evidence for action. 2003
Outcomes and Cost Data
Effect of Adherence on Outcomes
• Patients who stopped taking all of their cardiovascular medication one month after a heart
attack were three to five times more likely to die compared with those who continued at least
one of their medications (Ho et al, 2006).
• Patients with heart disease who reported taking their medications less than half the time had
almost double the risk of cardiovascular events (Gehi et al, 2007).
• Patients with diabetes and good medication adherence had 2.2% lower A1c level compared
to patients with poor adherence (Rhee et al, 2005).
Effect of Adherence on Costs
•
Although good adherence can lead to slightly higher medication costs in patients with
diabetes, high cholesterol or hypertension, total medical costs are about $1000 to $8,000 less
due to avoided hospitalizations (Sokol et al, 2005).
• For patients with diabetes, every 10% increase in adherence is linked with a 4% decrease in
total medical costs (Shenolikar et al, 2006).
WHO “Lessons Learned”
1. Patients need to be supported, not blamed
2. The consequences of poor adherence to long-term
therapies are poor health outcomes and increased health
care costs
3. Improving adherence also enhances patient safety
4. Adherence is an important modifier of health system
effectiveness
5. Improving adherence might be the best investment for
tackling chronic conditions effectively
6. Health systems must evolve to meet new challenges
7. A multidisciplinary approach towards adherence is needed
WHO: Adherence to long-term therapies: evidence for action. 2003
The 5 Dimensions of Adherence
WHO: Adherence to long-term therapies: evidence for action. 2003
Some factors associated with
adherence
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lower long-term medication safety concerns
greater trust in the prescribing care provider
higher perceived value of prescription medications
less perceived proneness to side effects
lower perceived value of supplements, minerals, and
vitamins
more knowledge about the prescribed medication
more perceived disease severity
better self-rated health
higher education attainment
WHO: Adherence to long-term therapies: evidence for action. 2003
Patient Barriers
• Complexity: “There are so many pills, I can’t keep them straight!”
• High cost: “I can’t afford my medicine so I will only take half a pill
today.”
• Difficulty remembering schedules: “I forget to take them.”
• Lack of understanding: “Why do I need them?”
• Not feeling sick: “I feel fine. I don’t need them.”
• Side effects: “The yellow pills make me feel sick and I heard the blue
pills give you liver problems.”
• Embarrassment/Stigma: “I don’t want my friends to know that I’m
sick.”
• Depression: “I don’t care…. What’s the point?”
• Health literacy: “I can’t understand these instructions!”
• Belief systems: “My sister took insulin, then had her leg
amputated.”
Practical Tips
• Assume patients are not taking their medications correctly.
• Ask: “What concerns you most about your medicine?”; “A lot of
people have trouble taking medicine the way their doctors ask
them to. What gets in the way of taking your medicine?”
• Review medications with patients: indications, directions for use,
side effects, cost-saving strategies – use the AVS
• Teach strategies for remembering medicine: pill boxes, cell phone
reminders
• Explain in plain language: how the medicine works, consequences
of not taking medicines, how to manage side effects
• Offer resources: PharmD, Patient assistance, MSW, $4 generics and
free meds
References
• http://www.nyc.gov/html/doh/downloads/pd
f/cardio/cardio-map-tools-manual.pdf
• http://apps.who.int/medicinedocs/en/d/Js488
3e/
Questions
• I have read each slide in this module and
understood its content
– True
– False