Medication Adherence [Autosaved].pdf

Medication Adherence Dr. Hrishikesh N. Gupta Assistant Professor, Government College of Pharmacy, Ratnagiri Medication Adherence Adherence: The degree to which the person’s behavior corresponds with the agreed recommendations from a healthcare provider Compliance: Th...

Medication Adherence Dr. Hrishikesh N. Gupta Assistant Professor, Government College of Pharmacy, Ratnagiri Medication Adherence Adherence: The degree to which the person’s behavior corresponds with the agreed recommendations from a healthcare provider Compliance: The extent to which a patient’s behavior matches the prescriber’s advice. Adherence includes the initiation of the treatment, implementation of the prescribed regime, and discontinuation of the pharmacotherapy Effectiveness of a treatment depends on patient adherence and efficacy of drug Patient literacy play vital role in adherence Adherence is not possible without cooperation of the patient Essential for optimum therapeutic outcome Non-adherence Primary (Initiation) - the frequency with which patients fail to fill prescriptions - it is related to refilling and initiation of the medication therapy Secondary nonadherence (Implementation) - the medication being not taken as prescribed when prescriptions are filled - affect the clinical and financial outcome of the health system  Causes of medication non-adherence Patient related Pharmacist related Doctor related factors factors factors Multiple-drug regimen Age, Gender Patient education Poor interaction with Patient counseling Education patient Physical disability Failure in inspiring Cultural attitudes confidence Economic factors Health system Prescription related factors related factors Disease related factors Illegible and inaccurate Long waiting Severity of disease prescription times Asymptomatic Failure to refill prescription Uncaring staff nature of disease Polypharmacy Accessibility Role of Pharmacist in patient adherence Keeping the regimen simplest by avoiding non-essential drugs Tailoring the regimen to connect dosing time with regular daily activities Patient education Use of audiovisual aids Accurate and specific labeling Medication calendars and drug reminder charts Improved dosage forms such as transdermal patches Determination of anticipated dates of last dose and follow up for refill in due time Methods to measure adherence Direct methods - Direct observed therapy - Detection of drug/metabolite in body fluids - Detection and measurement of biomarker added to the drug formulation More accurate Expensive and difficult to perform Variations in metabolism may give wrong results “White coat adherence” Drug-drug, drug-food interactions may alter the accuracy of assay Non-quantitative nature of biomarker Not suitable for psychiatric patients and patients on multidrug therapy Methods to measure adherence Methods involving secondary database analysis - sequences and patterns derived from the curated primary data in electronic prescription service or pharmacy insurance claim - allows quantification of medication adherence - Refill adherence measures Methods involving secondary database analysis Medication Possession Ratio (MPR) Days’ supply obtained/refill interval or fixed interval Dichotomous variable N/A (arbitrary cutoff value) Continuous, Multiple Interval Measure of Medication Cumulative days’ supply obtained over a series of Acquisition (CMA) intervals/total days from the beginning to the end of the time period Continuous, Multiple Interval Measure of Medication Cumulative days without any medication over a series Gaps (CMG) of intervals/total days from the beginning to the end of the time period Continuous, Single Interval Measure of Medication Days’ supply obtained in each interval/total days in Acquisition (CSA) the interval Continuous, Single Interval Measure of Medication Number of days without any medication/total days in Gaps (CSG) the interval Pill count (Number of dosage units dispensed − number of dosage units remained)/(prescribed number of dosage unit per day × number of days between 2 visits) Measures Involving Electronic Medication Packaging (EMP) Devices 1.Smart Pill Bottles: These bottles have sensors in the cap or bottle itself to track when the bottle is opened or the weight of the remaining pills. They can remind patients to take their medication and record the time and date of each opening. 2.Smart Blister Packs: These packs contain sensors in each cavity that record the date and time a pill is removed. This data can be uploaded to a computer or app for monitoring. 3.Medication Event Monitoring Systems (MEMS): These systems include electronic pill bottles, bags, or boxes with sensors that record every time the container is opened. They provide detailed adherence data. 4.Mobile Apps: Apps can serve as digital hubs, reminding patients to take their medications and allowing them to record their adherence history. Some apps also use gamification to encourage adherence. Measures Involving Clinician Assessments and Self-Report Patient-Kept Diaries Patient Interviews Questionnaires and Scales to evaluate- (i) only medication-taking behaviors (ii) both medication taking behavior and barriers to adherence (iii) only barriers to adherence (iv) only beliefs associated with medication adherence (v) Both barriers to and beliefs associated with adherence. Brief medication questionnaire self-report tool to screen patient adherence and barriers to adherence Screen -1 : 5 item screen (Regimen screen) - Measure adherence behavior - How many days did you take it? - How many times per day you take it? - How many pill did you take each time? - How many times did you miss taking a pill? Screen -2 : (Belief screen) - How well this drug/s work for you? - Do any of your medications bother you in any way? Screen -3 : (Recall screen) - How hard is it for you to remember to take all pills every day?