Medication adherence

Causes of medication non adherence; Pharmacist Role; Monitoring of medical adherence

1. Medication Adherence Dr. Subhash R. Yende Asst. Professor, Gurunanak College of Pharmacy, Nagpur 1

2. Introduction Medication Adherence : The patient’s conformance with the provider’s recommendation with respect to timing, dosage and frequency of medication-taking during the prescribed length of time. It is a factors that determines the therapeutic out comes, in a patient suffering from chronic illness/diseases. Compliance: How well the patient follows the instruction of when and how to take the medication Persistence : Duration of time patient takes medication, from initiation to discontinuation of therapy 2

3. Causes of medication non-adherence Socio-economic Poor socioeconomic status, illiteracy, unemployment Lack of family or social support lack of financial resources Busy work schedules High cost of medication Health care system related Relationship of doctor-patient Poor or lack of proper communication regarding the beneficial effect of taking medication, instructions for use and side effects Poor medication distribution 3

4. Therapy related Complexity of medical regimens, duration of treatments Lack of immediate benefit of therapy and treatment interferes with lifestyle Condition related Severity of symptoms (chronic illness requires long term drugs administration OR few or no symptoms) Patient related Impairments such as visual, hearing and cognitive impairments and swallowing problems Lack of motivation, apprehension about possible adverse side effects Stress, anxiety 4

5. pharmacists role in medication adherence Pharmacists can improve medication adherence because they can actually show the medication to the patient and relate any information to the medication itself. Educate patients regarding medication adherence Pharmacists can impart the information that patients need to know such as- Name and purpose of the drug, When and how to take the medication, Possible side effects, Precautions, Interaction with food or other drugs, Duration of therapy, Action to take if a dose is missed etc . 5

6. A pharmacist can advice to prescribers on the simplification of drug regimens and reinforcing factors which may contribute towards medication non-adherence. A pharmacists can assess the patient’s knowledge of their drug therapy and usual medication habits The pharmacists can also assess the patient’s ability to comprehend and recall information, and if an adverse drug reaction may discourage medication adherence. 6

7. Strategies to improve the pharmacist-patient relationship: Be friendly and approachable to the patient. Improve communication skills. Take into account the spiritual and psychological needs of the patient. Improving patient education. Give clear explanation. Check the patient understanding. Simplify the therapeutic regimes. Monitor the side effects. Monitor the beneficial effects. Speak the same language of patient. Involvement of patient treatment discussion. 7

8. Monitoring of medication adherence Assessment, quantification, measurement and evaluation of adherence Direct and Indirect methods The direct measurement includes – drug monitoring detection of the drug or its metabolites in biological fluid direct observation therapy Most accurate methods of adherence measurement but are expensive 8

9. The Indirect measurement includes – self reports, pill counts, rates of prescription refills, assessment of the patient’s clinical response measurement of physiologic markers as well as patient diaries 9

10. Direct Measurement :- Home finger prick sampling Biological markers Directly observed therapy Indirect Measurements:- Self-report measures (using questionnaires) Morisky’s medication adherence scale Medical outcome adherence study scale Brief Adherence Rating Scale Electronic Adherence monitoring 10

11. Reference https://www.slideshare.net/rameshganpisetti/medication-adherence-93414237 Dwajani S., Prabhu MR, Ranjana G., Sahajananda H. Importance of medication adherence and factors affecting it. International Journal of Compressive and advanced pharmacology, 2018, 3 (2), 69-77. 11