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Extent to which a patients behavior, taking medications, following a diet, and/or executing life style changes, corresponds with agreed recommendations from health care providers.
- Taking the medication
- Taking as prescribed
Success at adhering to medication therapy through to its intended duration
Why not compliance?
Adherence vs. Compliance
- Active vs Passive
- Pt empowered vs following MD
- Supportive vs punitive
- Factual vs judgmental
What is the average overall adherence to medications?
What happens after a prescription is written?
- Rx prescribed (100%) -->
- Rx filled (88%) -->
- Rx taken (76%) -->
- Rx continued (47%)
How many prescriptions on average are written annually (2010)?
How many prescriptions on average are filled annually (2010)?
3.3 billion (primary adherence)
How many prescriptions on average are taken annually (2010)?
2.8 billion (secondary adherence)
How many prescriptions on average are continued annually (2010)?
1.8 billion (persistence)
Average cost of a prescription (2010)?
How much money on average was wasted on unused prescriptions in 2010?
$109 billion wasted
(1.5 billion Rx paid for and not used)
Percent of elderly adherence?
Percent of adherence in patients with Depression?
Percent of adherence in patients with mental disorders?
How many elderly Medicare beneficiaries do NOT adhere simply because of cost?
Of those who get their prescription, what percent take less than they are supposed to?
Poor medication adherence as a cause of death, what rank?
4th leading cause of death
(estimate of 125,000 deaths in 2002)
Cost of medication NON-adherence (annual overall cost)?
Causes of poor adherence: Medication-related factors?
- Increasing number of daily medication doses
- Increasing number of concurrent medications
- Perceived or actual unpleasant adverse effects
- Long term therapy (eg, preventative therapy, asymptomatic conditions)
Causes of poor adherence: Patient-related factors?
- Mental illness & Substance abuse
- Lack of social support
- Unstable living environment
- Busy schedule
- Physical disability/mobility
- Health literacy
- Denial of illness
- Significant behavior change
- Perceptions (eg, low susceptibilty to disease or symptoms, actual severity of illness, benefits)
- Inability to follow regimen
Causes of poor adherence: Provider or System factors?
- Poor patient provider relationship
- Provider communication
- Lack of patient centeredness
- Follow up
- Uninsured (>9.4% to 50.7 million in 2009)
- - Cost of medications and co-payments
- - Access to providers
- causes of poor adherence are very patient specific (solutions must avoid one-size fits all)
- Requires coordination
- Multi prong interventions
How do you determine if a patient is adherent (Direct methods)?
- Drug concentrations
How do you determine if a patient is adherent (Indirect methods)?
- Asking (patient self-reporting, "Do you take your medication as directed" or "How do you take your medication")
- Pill counts
- Medication refill rates
- Assessment of clinical response
- Electronic medication monitors
- Medication diaries
How do you determine if a patient is adherent?
No method has been shown better than another
- Medication Possession Ratio (MPR)
- Proportion of Days Covered (PDC)
- Gap in therapy
What is considered good medication adherence?
Tools (Q's) to measure medication adherence?
- "Do you ever forget to take your medicine?"
- "Are you careless at times about taking your medicine?"
- "When you feel better do you sometimes stop taking your medicine?"
- "Sometimes if you feel worse when you take your medicine, do you stop taking it?"
- "Do you know the long-term benefit of taking your medicine as told to you by your doctor or pharmacist?"
- "Sometimes do you forget to refill your prescription medicine on time?"
How can you improve adherence (principles)?
- Is a complex behavioral process
- No single approach better than another
- Combination of approaches most successful
- Relationships and follow up important
How can you improve adherence?
Evidence based interventions:
- Simplify medication regimens
- Patient education
- Patient coaches (case management)
- Discharge counseling
- Comprehensive medication review or MTM that has follow up component
- Pill boxes or adherence aids
- Remove financial barriers
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