Medication Adherence

Erin Rank, PharmD CandidateThe Ohio State University College of

PharmacyMay 23, 2007

Quote for the Day

“Drugs don’t work in patients who don’t take them.”

- C. Everett Koop, M.D.

Questions for you……

What are some things that may make you not want to take your medications?

What are the benefits of your medications?

How do you remember to take your medications?

Objectives

DefinitionWHOs Three Pillars Facts and StatsImportance of medication adherencePredictors of poor adherenceBarriers to adherenceTips to improve adherence

What is medication adherence?

The extent to which a patient follows a medication regimen as prescribed by their doctor

Patient-centered Mutual understanding between patient and

doctorReplaced “compliance”No perfect term

What is medication adherence?

Influenced by many different factors:

Patient Practices of physician/healthcare team Insurance/health system Patient’s social support and environment

What’s the bottom line?

You can only get the full benefit of your medication if you follow your prescribed treatment plan

A few notes about medications

Can take weeks to months to workSkipping “a dose or two” CAN be a

problemMany side effects subside after awhileIf one med doesn’t work, there are many

others to tryHerbal products CAN interact

World Health Organization’s Three Pillars of Adherence

Three Pillars: Patient information Motivation Behavioral skills

*Motivation most important as it is key in long-term behavior changes

Adherence Facts

Higher adherence rate in acute vs. chronic conditions

Chronic diseases hit a low point after 6 months

50% of patients on ADs won’t be taking them after 3 months

Adherence decreases as # of meds increases

Adherence Facts

Adherence is hard to measure clinicallyMeans different things to different peopleRate of adherence can range from 0 to

over 100%Rates reported ~ 40-75% for chronic

diseases

Adherence Facts

Omitted or delayed doses most common“White-coat” adherenceIncreased dose frequency poor

adherence

Adherence to medication determined by dosing frequency

Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther

2001;23:1296-1310. 

What adherence patterns are typical in chronic disease?

1/6- Take few or no doses, but give good impression

1/6- Have nearly perfect adherence1/6- Drug holidays each month or more1/6- Drug holidays 3-4 times each year1/6- Miss an occasional dose1/6- Take almost all doses but have some

timing issues

Why do we care?

Poor adherence associated with increased death, worsening of disease, and increased costs to patient and health care system

Factors that contribute to poor adherence

Treatment of disease without symptomsComplex treatment planCostPoor relationship with doctorMissed appointmentsCognitive/psychological problemsPoor understanding of disease

Factors that contribute to poor adherence

Poor follow-up by physicianLack of patient “buy-in”Concern about taking drugsLimited social supportSubstance abusePhysical problems Anger about the illnessSide effects

Factors that contribute to poor adherence

COSTSIDE EFFECTS

Cost concerns

GenericsAsk your pharmacistTalk with your physician to increase

awareness Assistance for some medications that

insurance plan doesn’t cover

http://www.newstarget.com/021714.html. This site is part of the NewsTarget Network ©2004,2005 All Rights Reserved.

Side effect management

Common undesirable effects: Nausea Weight gain Sexual dysfunction Drowsiness Sleep changes Dry mouth Blurred vision

Side effect management

Common undesirable effects:

Constipation Dizziness Anxiety

Talk with your health care team—many ways to deal with these issues!

Why do patients report poor adherence?

Biggest problem—forgetfulnessDrugs don’t fit in lifestyleChose to miss dosesIncomplete informationDon’t know

Barriers on the provider side

Complex regimensDiscuss benefits/side effectsCost issuesConsideration of drug and lifestyle needsRelationship with patient

Barriers on the Health System side

FormulariesCo-payments/cost-shareProvider access

Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497.Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect on patient persistence with hypertension medications. Am J Manag Care 2005;11:SP27-SP34. Zyczynski TM, Coyne KS. Hypertension and current issues in compliance and patient outcomes. Curr Hypertens Rep 2000;2:510-514.

Interventions to improve adherence

Four main targets:

Patient education Increased provider access Improved communication between health care

team and patient Alterations in dosing schedules

What can you do?

Communication is key!

-Talk to your doctor/health care team-Know your insurance plan-Pick the plan that is right for you-Ask about generics and cheaper alternatives

What can you do?

Use reminders:

Sticky notes Beeping alarms Timers Pill box (count out doses in advance)

What can you do?

Support system friends, family, health-care team

Make your regimen fit your lifestylePlan ahead for refills/travel/weekendsWrite it down!

Journal, planner Write down when a dose is missed and why What works and what doesn’t

Remember………

There is a drug and/or regimen that can work for you!

Questions?

Thanks!

References

Osterberg, L., Blaschke, T. Adherence to medication. N Engl J Med 2005;353:487-497. Aruffo, S., Grey, S. Think you have a compliance problem? Think again. The Case Manager

2005;16:43-46. Vlasnik, J.J., Aliotta, S.L., DeLor, B. Evidence-based assesment and intervention strategies to

increase adherence to prescribed medication plans. The Case Manager 2005;16:55-59. Vlasnik, J.J., Aliotta, S.L., DeLor, B. Medication adherence: factors influencing compliance with

prescribed medication plans. The Case Manager 2005;16:47-51. About.com: http://aids.about.com/cs/adherence/tp/tenadherence.htm; Accessed May 4, 2007.

©2007 About, Inc., A part of The New York Times Company. Wilson J, Axelsen K, Tang S. Medicaid prescription drug access restrictions: exploring the effect

on patient persistence with hypertension medications. Am J Manag Care 2005;11:SP27-SP34.  Zyczynski TM, Coyne KS. Hypertension and current issues in compliance and patient outcomes.

Curr Hypertens Rep 2000;2:510-514. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens

and medication compliance. Clin Ther 2001;23:1296-1310.