Presentation on theme: "Medication Adherence Erin Rank, PharmD Candidate The Ohio State University College of Pharmacy May 23, 2007."— Presentation transcript:
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 long- term 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 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
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, health- care 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!