Medication Adherence

Presentation detailing the basics and boundaries of medication adherence.

1. Medication Adherence: Defining the Problem November 7, 2012 Marquila Ferrell & Sarah Hudson The University of Toledo

2. Objectives 2 Define medication adherence E xplore the differences between medication adherence and medication compliance Identify associated statistics Factors that contribute to medication adherence Why medication adherence matters?

3. Introduction Script Your Future. (2012). National Consumers League . 3 125,000 people die a year due to failure to take medication or taking medications improperly Almost 6 out of 10 people are taking at least one prescription drug More than 1 in 3 medicine-related hospital admissions occur due to people not properly adhering to their medications

4. What is Medication Adherence? Osterberg , L., &  Blaschke , T. (2005). Adherence to medication. New England journal of medicine , 353 (5), 487-97. 4 “The extent to which patients take medications as prescribed by health care providers.”

5. Medication Adherence vs. Patient Compliance Osterberg , L., &  Blaschke , T. (2005). Adherence to medication. New England journal of medicine , 353 (5), 487. 5 “Compliance suggests that the patient is passively following the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between the patient and the physician.”

6. Medication Non-Adherence Ho, P., Bryson, C., , & Rumsfeld, J. (2009). Medication adherence: I ts importance in Cardiovascular O utcomes . Circulation , 119 (23), 3031. 6 Intentional medication non-adherence “Active process whereby the patient chooses to deviate from the treatment regimen.” Unintentional medication non-adherence “Passive process in which the patient may be careless or forgetful about adhering to treatment regimen.”

7. Effects of Medication Non-Adherence 7 Increased hospital readmission Increased disease progression and complications Increased health care costs Decreased quality of life Patient death

8. Patient Interviews 8 “ Taking my medication helps balance my life. I f I do not take it, I often get sick or have emotional episodes.”

9. Why Don’t Patients Take Their Medicine? Express Scripts (2012). Retrieved from http :// lab.express-scripts.com / wp -content/uploads/2012/07/Americas_317B_Condition.pdf 9

10. 5 Dimensions of Medication Adherence Adult Meducation (2006). Overview of Medication Adherence. American Society on Aging and American Society of Consultant Pharmacists Foundation. 10

11. Clinical Case Study Ye, Siqin , Krupka , David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with myocardial infarction. Frontiers In Psychology , 3:267, 1 -3. 11 Primary source 48 year old African American male with low socioeconomic status presenting myocardial infarction and end-stage renal disease Assessment of medication adherence behaviors Psychological screening Questionnaires Post-discharge phone interview Electronic pill bottle

12. Post-Discharge Report Ye, Siqin , Krupka , David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with myocardial infarction. Frontiers In Psychology , 3:267, 7. 12 Measures Details Results Barriers to adherence Asks whether Rx were filled , and if not, reasons why not No barriers self-reported Morisky scale 8 item self-report medication adherence scale 2/8 score Modified CARDIA scale For each medication, self-reported # of days in week meds were taken 7/7 for all medications Electronic pill bottle # of days pill bottle was opened, divided by total # of days monitored Aspirin 6/31 Statin 3/31 B-blocker 2/31 Clopidogrel 0/31

13. Study Results Ye, Siqin , Krupka , David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with myocardial infarction. Frontiers In Psychology , 3:267, 4. 13 Limitations to medication adherence for Mr. P Low socioeconomic status Lived alone Distrust in medications efficacy Belief medications being overused Outcomes Hypertension poorly controlled Intermittent chest pain Progression of coronary artery disease concern

14. Summary 14 What medication adherence is Significance of adhering to medications Barriers to proper medication adherence Pharmacists and MTM services Health outcomes and pharmacy administrators

15. Questions 15

16. Resources 16 Adult Meducation . (2006). Overview of Medication Adherence. American Society on Aging and American Society of Consultant Pharmacists Foundation . Retrieved from http :// www.adultmeducation.com /OverviewofMedicationAdherence_4 . html. Express Scripts (2012). Retrieved from http:// lab.express-scripts.com / wp -content/uploads / 2012 /07/ Americas_317B_Condition.pdf Ho , P., Bryson, C., , & Rumsfeld, J. (2009). Medication adherence: its importance in cardiovascular outcomes. Circulation , 119 (23), 3028-35 . Retrieved from http:/ / www.ncbi.nlm.nih.gov / pubmed / 19528344. Osterberg , L. ,  &  Blaschke , T. (2005). Adherence to medication. New England journal of medicine , 353 (5), 487-97 . Retrieved from http:/ / www.nejm.org / doi /full / 10.1056 / NEJMra050100. Script Your Future. (2012). National Consumers League . Retrieved from http :/ / scriptyourfuture.org /medication -adherence/. Ye , Siqin , Krupka , David, & Davidson, Karina. (2012). Diagnosing medication non - adherence in a patient with myocardial infarction. Frontiers In Psychology , 3:267, 1 -7. Retrieved from http :/ / www.ncbi.nlm.nih.gov /pmc/articles /PMC3411184/.