Transcript Medication Adherence in the Geriatric Population

Medication Adherence and Rates
• Adherence is defined as “the extent to which a person’s behavior-taking medications, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a
healthcare provider” (Sabaté, 2003)
• There are 43.1 million elderly citizens in the United States (National Center for Health Statistics, 2014)
• From 2007-2010, 50% of adults 60 and older took 1-4 medications in a month (National Center for Health Statistics, 2014)
• 37% of Chinese geriatric patients do not take their medications as prescribed (Lam, Lum, & Leung, 2007)
• 51% of geriatric patients need help remembering to take their medications (Sanders & Oss, 2013)
Medication Influences
Costs of Low Adherence
• Best indicator of adherence is medication class (Fischer et al., 2010) Ex. Psychiatric
medications are adhered less often (Tsai et al., 2012)-possibly due to side effects
• Polypharmacy- (taking/prescribing multiple medications) contributes to a
complicated patient treatment plan and lower adherence.
• 42% of patients taking 3 ≥ medications had low adherence (Lam, Lum, & Leung,
2007)
• Low adherence costs Americans $290 billion each year (New England
Health Institute, 2009)
• 125,000 deaths are due to low adherence (Vik, Maxwell, & Hogan
2003; Tsai et al., 2012)
• 10% of hospitalizations, 23% of nursing home admissions are due to
low adherence (Vik, Maxwell, & Hogan, 2003; Peterson, Takiya, &
Finley; Tsai et al., 2012)
• Side effects/withdrawal patients experience from skipping or forgetting
a medication dose
• Patients with low medication adherence may skip follow up physician
visits
Risk Factors for Low Medication Adherence
• Depressed patients take their medications and refill prescriptions less regularly
(Kilbourne et al., 2005)
• Low self-efficacy of one’s ability to take his or her medications is correlated with
low adherence in HIV patients (Colbert, Sereika, & Erlen, 2012)
• Misinformed perception of medications/illness affect adherence rates (Mann,
Ponieman, Leventhal, & Halm, 2009)
Outcomes of Pharmacist Intervention to Improve Medication
Adherence
Variable
Treatment as Usual
n=192
67.9%
(63.8-72.1)
66.7%
(62.3-70.9)
47%
(43.4-50.9)
Pharmacist Intervention
n=122
78.8%
(74.9-82.7)
70.6%
(64.9-76.2)
53%
(49.1-57.1)
Medication Adherence
During Intervention (CI)
Medication Adherence 3
Months Post (CI)
Medications Taken On
Schedule During
Intervention (CI)
Medications Taken On
48.6%
48.9%
Schedule After Intervention (44.7-52.6)
(43.7-54.1)
(CI)
Hospital Admissions (SD)
0.97 (1.78)
0.78 (1.66)
Emergency Department
2.68 (4.87)
2.16 (3.31)
Visits (SD)
Trends: overall outpatient costs in intervention group were $886 (CI, -$2289-660)
lower than the treatment as usual group. Each subject in the intervention group
saved about $2960 (CI, -7603-1338) in healthcare costs.
Figure 1. (Murray et al., 2007)
Healthcare Providers can Improve
Medication Adherence
• Recognize the signs of low adherence
• Be aware of the number of medications a patient takes
• Limit the number of medications prescribed (Lam, Lum, &
Leung, 2007)
• Educate patients on their illness and medications
• Use screening measures (BMQ, MMAS, REALM-SF)
• Improve and sustain patient-provider communication
(Murray et al., 2007; Cohen et al., 2012)
• Use integrated healthcare teams involving pharmacists,
social workers, nursing staff and physicians (Lee et al.,
2013)
• Improve medication bottle labeling (Bailey et al., 2014)
• Ask patients about social support (family, friends,
healthcare providers)-this can increase adherence by 25%
(Lam, Lum, & Leung, 2007)
• Pharmacists who were trained to work with low literacy
heart failure patients and recognize signs of low adherence
improved patient adherence rates, decreased health costs,
and decreased hospital admissions (Murray et al., 2007)
Future Research Implications
• Research on geriatric medication adherence in the U.S. is
needed
• Research focusing on decreasing polypharmacy is needed
• Further developing research based interventions is
essential to improving medication adherence
• Implementing self report recommendations suggested by
patients is important to decreasing medication adherence
References
Bailey, S. C., Wolf, M. S., Lopez, A., Russell, A., Chen, A. H., Schillinger, D., Moy, G., & Sarkar, U. (2014). Expanding the universal medication schedule: A
patient-centered approach. BMJ Open, 4(1), 1-7.
Cohen, M.J., Shaykevich, S., Cawthon, C., Kripalani, S., Paasche-Orlow, M.K., & Schnipper, J.L. (2012). Predictors of medication adherence postdischarge: the
impact of patient age, insurance status, and prior adherence. Journal of Hospital Medicine, 7(6), 470-475.
Colbert, A.M., Sereika, S.M., & Erlen, J.A. (2012). Functional health literacy, medication-taking self-efficacy and adherence to antiretroviral therapy. Journal
of Advanced Nursing, 69(2), 295-304.
Fischer, M. A., Stedman, M. R., Lii, J., Vogeli, C., Shrank, W. H., Brookhart, M. A., & Weissman, J. S. (2010). Primary medication non-adherence: Analysis of
195,930 electronic prescriptions. Journal of General Internal Medicine, 25(4), 284-290.
Holt, E., Joyce, C., Dornelles, A., Morisky, D., Webber, L. S., Muntner, P., & Krousel-Wood, M. (2013). Sex differences in barriers to antihypertensive
medication adherence: Findings from the cohort study of medication adherence among older adults. Journal of the American Geriatrics Society, 61(4),
558-564.
Kilbourne, A. M., Reynolds, C. F., Good, C. B., Sereika, S. M., Justice, A. C., & Fine, M. J. (2005). How does depression influence diabetes medication
adherence in older patients? The American Journal of Geriatric Psychiatry, 13(3), 202-210.
Lam, P. W., Lum, C. M., & Leung, M. F. (2007). Drug non-adherence and associated risk factors among Chinese geriatric patients in Hong Kong. Hong Kong
Medical Journal, 13(4), 284-92.
Lee, V. W. Y., Pang, K. K. W., Hui, K. C., Kwok, J. C. K., Leung, S. L., Yu, D. S. F., & Lee, D. T. F. (2013). Medication adherence: Is it a hidden drug-related problem
in hidden elderly? Geriatrics & Gerontology International, 13(4), 978-985.
Mann, D.M., Ponieman, D., Leventhal, H., & Halm, E.A. (2009). Predictors of adherence to diabetes medications: the role of disease and medication beliefs.
Journal of Behavioral Medicine, 32(3), 278-284.
Murray, M. D., Young, J., Hoke, S., Tu, W., Weiner, M., Morrow, D., Stroupe, K.T., Wu, J., Clark, D., Smith, F., Gradus-Pizlo, I., Weinberger, M., & Brater, D. C.
(2007). Pharmacist intervention to improve medication adherence in heart failure: A randomized trial. Annals of Internal Medicine, 146(10), 714-725.
National Center for Health Statistics. (2014). Health, United States, 2013: With Special Feature on Prescription Drugs. Washington, DC: Government Printing
Office.
New England Healthcare Institute. (2009) Thinking outside the pillbox: a system-wide approach to improving patient medication adherence for chronic
disease. Retrieved from http://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf
Sabaté, E. (2003). Adherence to long-term therapies evidence for action. Switzerland: World Health Organization.
Sanders, M.J., & Van Oss, T. (2013). Using daily routines to promote medication adherence in older adults. The American Journal of Occupational Therapy,
67, 91-99.
Tsai, K.T., Chen, J.H., Wen, C.J., Kuo, H.K., Lu, I.S., Chiu, L.S., & Chan, D.C. (2012). Medication adherence among geriatric outpatients prescribed multiple
medications. American Journal of Geriatric Pharmacotherapy, 10(1), 61-68.