-
Adherence
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.
-
Medication Adherence
- Taking the medication
- Taking as prescribed
-
Persistence
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?
50%
-
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)?
3.8 billion
-
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)?
$73
-
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?
40-75%
-
Percent of adherence in patients with Depression?
35-65%
-
Percent of adherence in patients with mental disorders?
50-68%
-
How many elderly Medicare beneficiaries do NOT adhere simply because of cost?
2 million
-
Of those who get their prescription, what percent take less than they are supposed to?
22%
-
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)?
$250 billion
-
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
- Finances
- 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
-
poor adherence
- 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)?
- Observe
- 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
Quantitative analysis
- Medication Possession Ratio (MPR)
- Proportion of Days Covered (PDC)
- Gap in therapy
-
What is considered good medication adherence?
80%
-
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
|
|
