Medication Adherence Strategies Quiz
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Questions and Answers

What is the most accurate definition of medication adherence?

  • The patient's willingness to take their medication as prescribed
  • The patient's ability to follow prescribed instructions
  • Passive behavior in which the patient is following instructions from the provider
  • Active, voluntary and collaborative involvement in a mutually accepted therapeutic course (correct)

    • Which of the following is NOT a potential negative outcome associated with nonadherence?

  • Increased risk of hospitalization
  • Decreased treatment effectiveness
  • Increased healthcare costs
  • Improved patient satisfaction (correct)

    • Which of the following is a recognized advantage of using the DRAW tool to assess adherence?

  • It is a standardized, objective measure of adherence.
  • It helps identify barriers to adherence.
  • It is easy to administer and interpret.
  • All of the above (correct)

    • Which of the following is NOT a type of question commonly used in the DRAW Tool?

    <p>Questions about the patient's past history of nonadherence (A)</p> Signup and view all the answers

    What is one predictor of nonadherence that can be identified using the AIM Model?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT considered a cause of medication nonadherence?

    <p>Patient's preference for alternative therapies (C)</p> Signup and view all the answers

    What is the main objective of the "Take Home Assignment" activity?

    <p>To learn about medication adherence challenges. (D)</p> Signup and view all the answers

    Which of the following strategies can be used to prevent medication nonadherence?

    <p>All of the above (D)</p> Signup and view all the answers

    Which tool is used to identify patient non-adherence with a medication regimen in the lab activity?

    <p>DRAW © tool (C)</p> Signup and view all the answers

    What is the primary goal of the lab activity "Part II" ?

    <p>To develop patient-centered strategies for improving medication adherence. (D)</p> Signup and view all the answers

    Which of the following is NOT a strategy to resolve medication nonadherence?

    <p>Ignoring the patient's concerns and imposing a strict regimen (D)</p> Signup and view all the answers

    What is the purpose of rotating roles in "Part II: Lab Activity"?

    <p>To allow students to experience the role of a patient and a healthcare professional. (D)</p> Signup and view all the answers

    How many different medication adherence scenarios are included in the "Take Home Assignment" activity?

    <p>Five (C)</p> Signup and view all the answers

    According to the assignment instructions, what should students do with their medication vial after completing the "Take Home Assignment"?

    <p>Bring it back with them to class on January 7th. (C)</p> Signup and view all the answers

    What is the primary purpose of providing adherence scenarios through email in the "Take Home Assignment"?

    <p>To provide students with examples of different medication adherence barriers. (D)</p> Signup and view all the answers

    During the "Take Home Assignment", how are student pharmacists evaluated?

    <p>Based on their ability to identify reasons for missed doses. (D)</p> Signup and view all the answers

    What is the most significant impact of physical limitations on medication adherence?

    <p>Increased risk of adverse medication effects due to improper administration. (C)</p> Signup and view all the answers

    How can the impact of physical limitations on medication adherence be mitigated?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the primary objective of the lab activity described in the content?

    <p>To provide students with hands-on experience in navigating the challenges associated with physical limitations in medication adherence. (B)</p> Signup and view all the answers

    Considering the content, why is it important for student pharmacists to participate in this lab activity?

    <p>All of the above. (D)</p> Signup and view all the answers

    How can the information from this lab activity be applied to real-world scenarios?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the primary purpose of the lab activity's focus on physical limitations?

    <p>All of the above. (D)</p> Signup and view all the answers

    Which of the following statements accurately reflects the role of pharmacists in addressing medication adherence?

    <p>Pharmacists play a crucial role in identifying and addressing barriers to medication adherence, collaborating with other healthcare professionals to optimize patient outcomes. (B)</p> Signup and view all the answers

    What is the significance of reflecting on how physical limitations can be overcome to improve adherence?

    <p>All of the above. (D)</p> Signup and view all the answers

    Study Notes

    Medication Adherence Predictors, Barriers and Prevention Strategies

    • Medication adherence refers to the extent a person follows a healthcare provider's recommendations, encompassing taking medications correctly, following diet/exercise plans and attending appointments
    • Adherence is dependent on a good patient-provider relationship
    • Medication adherence plays a significant role in successful treatment outcomes for chronic conditions
    • Non-adherence to medications has been estimated to cause 125,000 preventable deaths yearly
    • 30-50% of medications are associated with adherence issues
    • The cost of non-adherence is substantial, with an estimated $100 billion in preventable health care costs annually and a yearly increase of 5% in prescription costs.
    • Estimated adherence rates for chronic diseases are approximately 50%. Examples include: hypertension, hypercholesterolemia and asthma

    Patient Case Scenario

    • A 51-year-old male patient with heart failure (HFrEF) presented to the pharmacy with an exacerbation
    • Patient was out of furosemide and carvedilol
    • Patient did not like the side effects of furosemide and sometimes missed the second dose of carvedilol
    • Patient reported difficulty using their cellphone, preferring in-person pharmacy visits.
    • The patient's primary care physician expressed concern over the patient's non-adherence.

    Past Medical History

    • Hypertension
    • HFrEF
    • Hyperlipidemia
    • Myocardial Infarction
    • History of illicit drug use

    Social History

    • Mother and father died from MI (Myocardial Infarction) at ages 60 and 51, respectively.
    • Siblings (3 brothers, 1 deceased, 3 sisters) also have a history of MI (and Hypertension).
    • Divorced, lives alone, monogamous female partner.
    • Truck driver for 30 years, self-insured Medicaid.
    • (+) 1 1/2 packs of tobacco per day for 25 years.
    • (+) 1-2 beers per day.

    Pre-Question #1

    • The correct answer is D. Active, voluntary, and collaborative involvement in a mutually accepted therapeutic course.

    Pre-Question #2

    • The most common misconception is A. It is the provider's role to primary manage a patient's chronic disease state.

    Pre-Question #3

    • A commonly known risk factor for JW's non-adherence is D. Job instability.

    Pre-Question #4

    • The intervention that is NOT considered a behavioral intervention to improve adherence is C. Increase the frequency of visits.

    Learning Objectives

    • Define medication adherence
    • List potential negative outcomes associated with nonadherence
    • Know advantages and disadvantages of various adherence measures
    • Identify the purpose and types of questions used in the DRAW tool
    • Identify predictors of nonadherence
    • Describe causes of nonadherence using the AIM model (Ability, Information, Motivation)
    • Identify strategies to prevent and resolve nonadherence consistent with the underlying cause(s).

    Change in Terminology

    • The term compliance is being replaced with adherence, as the later more accurately reflects a collaborative relationship between patients and Healthcare Providers

    Defining Adherence

    • The extent to which a person's behavior corresponds with agreed recommendations from a healthcare provider.

    Defining Medication Adherence

    • Extent to which patients take the medications prescribed
      • Filling the prescription
      • Taking medications at the correct time
      • Taking the correct dose

    Concordance

    • Forming a therapeutic alliance to optimize health through optimal medication use, compatible with the desires and capabilities of the patient.

    Examples of Concordance in Practice

    • Patient #1 requires frequent blood glucose monitoring (6 times daily).
    • Patient #2 misses several doses of prescribed medication Eliquis due to work.

    The Leaky Bucket

    • Demonstrates several causes for non-adherence, such as not refilling prescriptions as prescribed, not taking medications properly, not picking up prescriptions from a pharmacy or delays to relaying prescription information.

    Non-Adherence Statistics

    • Non-adherence to medications for conditions like hypertension, hypercholesterolemia, asthma, are commonly encountered issues.
    • Adherence rates are generally better for acute medical conditions than chronic conditions.

    Non-Adherence Rates

    • Adherence rates in acute conditions tend to be better than chronic conditions.
    • Primary non-adherence in asthma was reported to range between 17% & 48%

    The Cost of Nonadherence

    • Nonadherence to medications is estimated to cause 125,000 preventable deaths annually, costing $100B in preventable healthcare costs, and leading to a 5% annual increase in prescription costs.

    Consequences of Poor Adherence

    • Non-adherence may lead to progression of diseases/conditions requiring hospitalizations, emergency room visits and increased/higher costs associated with further treatment

    Provider Misconceptions

    • Providers assume that the issue of patient non-adherence is an issue they "manage", overlooking the significant contributors
    • Believing that patients should inherently comply without acknowledging that certain patient conditions increase the difficulty &/or necessity of complying.
    • Provider's may wrongly assume that elderly patients have lower adherence rates than younger populations, which is not universally true.

    Predictors of Poor Medication Adherence

    • Presence of depression or cognitive impairment
    • Treatment of asymptomatic illness
    • Inadequate follow-up/discharge planning
    • Side effects of medication
    • Complexity of medications (number, doses, timing)
    • Poor Patient-Provider relationship
    • Missed/skipped appointments
    • High medication costs or co-payments
    • Presence of barriers

    Barriers to Adherence

    • Cost of medications (patient out-of-pocket costs): A top reason for medication non-adherence
    • Almost 75% of discharge medications face access barriers.
    • Non-adherence is exacerbated by lack of insurance or underinsurance.

    FYI: Defining the Federal Poverty Level (FPL)

    • Includes figures related to income levels and family sizes based on FPL 2022-2023

    Who are the Uninsured?

    • Demographics of populations with financial barriers in access to health services.
    • 28.5 million uninsured
    • 29% unable to pay their medical bills

    Causes of Non-adherence (AIM Model)

    • Ability (related to patient's limitations, side-effects, cognitive problems)
    • Information (lack of understanding the disease or medication)
    • Motivation (concerns and/or lack of commitment)

    Assessing Medication Adherence

    • There is no standard for assessing medication adherence, with differing percentages (80-95%) considered to be adherent depending on the study.
    • Some methodologies include observing whether the dose has been taken correctly over a period of time, including the time of administration.

    The Many Forms of Non-Adherence

    • Omissions of doses, incorrect timing, incorrect dosage, non-compliance with a medication regimen, stopping treatment prematurely or early.

    Measures of Adherence

    • Direct methods involve observing patients directly taking medication. This can be expensive, and have the potential for bias.
    • Indirect methods include patient self-reporting or questionnaires, pill counts and assessment of clinical response.

    Examples of Direct Methods

    • Directly observed therapy (watching someone take medication)
    • Measuring drug concentration in blood and/or urine (ex. phenytoin, valproic acid, warfarin)
    • Measuring biologic markers (ex. HIV viral load, hemoglobin A1c)

    Examples of Indirect Methods

    • Patient self-report questionnaires
    • Pill counts/dumping
    • -- Same pharmacy, same medication, same therapy?

    Verbal Approaches to Assess Adherence

    • Use open-ended questions (e.g., "On a scale of 1 to 10, how important is it for you to take your medication?").
    • Confirming with patients that medication use might be difficult.
    • Using "I" messages and focusing on the provider's concern without judging the patient's behavior.
    • Probing for more detailed information regarding reasons and/or circumstances if patients report or acknowledge difficulties.
    • Follow up with "If adherence difficulties are ongoing, how can we alleviate these?”

    Avoid the Threatening Approach

    • Use positive and supportive communication.
    • Focus on collaboration; validate patients' opinions/concerns.
    • Create opportunities for a discussion about their concerns.

    Strategies for Improving Adherence

    • Tailored services (patient tools/resources, motivational interviews, medication calendars, enhanced follow-up).
    • Simplify the treatment regimen.
    • Reduce the number of medications (use combination drugs when appropriate).
    • Use generic substitutions, drug interchange programs to increase affordability.
    • Consider alternative methods (hospitals/dispensaries).

    Reminder Tools

    • Use of (texts, alarms, apps, smart bottles, pillboxes) or other technological tools.

    Improving Adherence: Guided Counseling

    • Use open-ended questions to discover reasons for non-adherence.
    • Listen for needs & desires
    • Help patients identify and understand factors influencing/affecting their adherence.
    • Encourage commitments & support to resolve any issues.

    Improving Adherence: Cost Reduction Strategies

    • Reduce the amount of medication prescriptions.
    • Use combination medications as much as possible.
    • Use a generic substitution for a more expensive brand name drug (whenever possible).
    • Use other methods to assist patients with cost reductions

    Improving Adherence: Symptom Management

    • If a patient expresses side effects concerns, consider whether the symptoms are consistent with medications or if they require treatment and/or a change.

    Improving Adherence: Simplifying the Regimen

    • Improve dosing schedules to include longer-acting/half-life methods (injections/patches) to reduce unnecessary dosing frequency.
    • Combining/reducing medications whenever possible

    Improving Adherence Digital Health

    • Utilize various apps, smart bottles, pill boxes, smart dispensing devices for medication adherence improvements

    Improving Adherence Physical ADLs

    • Assess patient ability to prepare meals, conduct phone calls, or use an adherence aid without any assistance.

    Improving Adherence: Other Factors

    • Assess possible cognitive issues.
    • Consider the use of alternative care givers.
    • Consider whether other medications are contributing to cognitive/memory decline.

    In summary

    • Medication non-adherence to chronic diseases is a common patient problem.
    • Health care providers need to recognize indicators of poor adherence.
    • Collaboration with patients to improve medication adherence by utilizing tools, mechanisms & programs.

    Question #1

    • The correct answer is D. Active, voluntary, and collaborative involvement in a mutually accepted therapeutic course.

    Question #2

    • The most common misconception is A. The provider is solely responsible for managing the patient's chronic disease state.

    Question #3

    • One risk factor for the patient's non-adherence is D. Job instability.

    Question #4

    • The intervention that is NOT considered a behavioral intervention to improve adherence is C. Increase the frequency of visits.

    Lab Activity: Part I and Part II

    • A hands-on experience for student pharmacists to understand how physical limitations affect medication adherence
    • To identify and understand the various patient reasons for non-adherence to medications
    • To formulate solutions to resolve the identified problems

    Take Home Assignment

    • Medication Adherence assignment to apply learning gained in class

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    Related Documents

    Medication Adherence: Barriers, Predictors, and Strategies PDF

    Description

    This quiz explores the predictors, barriers, and prevention strategies related to medication adherence. Understanding adherence is vital for improving treatment outcomes for chronic conditions. Test your knowledge on the significance of patient-provider relationships and the impact of non-adherence on health care costs.

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