Adherence in Treatment
PST
06102
:
Counselling and Guidance
Session 14:
Adherence in the Treatment
1
Learning tasks
At the end of this session, students are expected to be able to
:
Give Introduction to adherence in the treatment
Describe difference between adherence, compliance and concordance in the treatment
Describe importance of adherence in the treatment
Explain reasons for non-adherence in the treatment
Explain methods of improving adherence in the treatment
2
Activity:
Buzzing
What is adherence in the treatment?
3
Adherence
in the treatment
Adherence: is defined as the extent to which a patient takes medication in the way intended by a health care provider,
This
is include, patients taking all medications at the correct time, in the appropriate quantities and in line with additional instructions regarding food or drug interactions
Medicines play an important role in medical care and effectiveness of treatment depends on both the efficacy of medication and patient adherence to the therapeutic regimen.
4
Adherence in the
treatment ….
Adherence to medication is essential to achieve the best possible pharmacotherapy outcomes.
Evidence
shows that non-adherence medications result in higher health care costs, longer hospitalization, and increased morbidity and mortality.
5
Adherence in the
treatment …
A
medication
is the most frequent intervention within healthcare systems
worldwide.
Achieving
the best possible outcome of medication for the quality of life of patients should be the primary aim of all health professionals involved in the medication process, as well as carers and patients, depending on their abilities and capacities
Adherence is a major issue for long term medication in chronic diseases, between 1/3 to ½ of medicines prescribed are not taken as intended, this affects: Patients’ health leading to decreased quality of life, complications, preventable hospitals admissions and
mortality/morbidity
6
Adherence in the
treatment ….
Non-adherence in the society increased healthcare cost/government spending, untreated diseases expose the society to potential problems such as infectious diseases like TB/HIV, psychiatric diseases
e.t.c
Medication non adherence can be divided into four categories:
Primary non adherence
Secondary non adherence
Unintentional non adherence
Intentional non adherence
7
1. Primary
non adherence
: is when a patient does not fill an initial prescription;
2. Secondary
non adherence
: is when a patient does not refill a prescription on time.
3. non
adherence
: occurs when a patient simply forgets to take medication or is careless in some way as to miss a scheduled dose;
4. Intentional
non adherence
: is a decision of not taking the medication, and may be the most important aspect of non adherence that must be addressed, with some estimates showing that up to 80 percent of non adherence may be intentional
8
Differences between adherence, compliance and concordance
In contrast, compliance and adherence relate to the medicine-taking behavior of the patient.
Compliance and adherence can be estimated using prescription claims records, pharmacy dispensing data, validated survey instruments or electric pill counters, as well as direct measures such as serum drug levels
However, the definition of concordance implied that the prescriber and patient should come to an agreement about the regimen that the patient will take
9
10
Important of Adherence in the Treatment
Treatment adherence is generally regarded as an important factor in achieving optimal outcomes across many disease
states.
In
the treatment of chronic disease like HIV, Cancer and tuberculosis, poor adherence to treatment has the potential to impact outcomes on multiple levels.
The health system in where pharmaceutical personnel practices is integral to achieving the ultimate goal of improved patient health, because medication adherence is an important contributor to improved patient health, health care systems must evolve in a way that emphasizes its importance.
11
Therefore the importance of adherence in the treatment are:
To decrease morbidity and mortality in the community and reduce health cost
Help to improve effectiveness of medicines
Strengthen relationship between patients and health workers
Lessening number of
hospitalities
12
Reasons for Non-adherence in the Treatment
Medication non-adherence is a serious problem with possible life-threatening consequences.
Patients
frequently are unable to recognize their own adherence issues, especially for chronic medications
Reasons for non-adherence to prescribed medicines are commonly divided into 5 intersecting categories;
Patient variables.
Treatment regimen.
Disease characteristics.
Patient provider relationship.
Clinic setting
13
Patient Variables
Sociodemographic factors
i.e
. age, gender, race/ethnicity, income, education, literacy, housing status, insurance status
Psychosocial factors
i.e
. mental health, substance use, social climate and support, knowledge and attitudes about disease and its treatment.
Common predictors of non-adherence include depression/psychiatric morbidity, active drug or alcohol use, stressful life events, lack of social support, and the inability to correctly identify the drug regimen or describe the relationship between adherence and drug resistance
.
14
Treatment Regimen
Factors related to the treatment regimen include:
The number of pills prescribed, the complexity of the regimen
ie
. dosing frequency and food instructions, the specific type of medicines dispensed, the short- and long-term medication side effects.
The complexity of the regimen and side effects caused by it are clearly associated with non-adherence, the impact of once-daily regimens on adherence behavior, amid great hope for a beneficial effect
15
Disease Characteristics
Disease characteristics include the stage and duration of infection, associated opportunistic infections, and disease-related symptoms, there is a relationship between disease-related symptoms and non-adherence.
16
Patient-Provider Relationship
Patient-provider relationship characteristics that may affect adherence include;
The
patient's overall satisfaction and trust in the provider and clinic staff, the patient's opinion of the provider's competence, the provider's willingness to include the patient in the decision-making processes
The affective tone of the relationship
ie
. Warmth, openness and cooperation, the concordance of race/ethnicity between patient and provider and the adequacy of referrals
.
17
Patient-Provider Relationship
May
affect adherence include;
The patient's overall satisfaction and trust in the provider and clinic staff, the patient's opinion of the provider's competence, the provider's willingness to include the patient in the decision-making processes
The affective tone of the relationship
ie
. Warmth, openness and cooperation, the concordance of race/ethnicity between patient and provider and the adequacy of referrals
18
Clinical
Setting
Absence
of ongoing primary care, unavailability of transportation and childcare, unpleasantness of the clinical environment, inconvenience in scheduling appointments, lack of confidentiality and dissatisfaction with prior experience in the health care system all has been associated with non-adherence.
Adjustable factors that impact adherence should be attended to, if possible, prior to starting medicines, and in a proactive and ongoing way throughout therapy, clinicians working with patients on medicines need an accurate and relatively simple method of assessing adherence in order to support its vital role in treatment outcomes.
Clinical setting and service delivery factors such as poorly motivated, unfriendly, inconvenient appointments and inadequate counseling leads to non-adherence
19
20
Factors contributing to non-adherence
Forgetting to take the medicine
Affordability
Concern about safety or effectiveness
Fear of or experiencing adverse effects
Confusion over the directions
.
No longer feeling unwell or not feeling any different
Feeling that they cannot manage with the number of medicines they should take
and how to coordinate them
Having dexterity challenges
Simply being too unwell
21
22
Methods of Improving Adherence in the Treatment
The best way to improve adherence is to involve patients in decisions making about prescribed medicines and to support adherence – patient
centered
care which include:
a
.
Good
communication
, there must be good communication between patients and pharmaceutical personnel so that patient needs can be identified and attended
b. Patient’s
capacity assessment
, By considering patient ability and capacity, if he/ she agrees, families and careers’ should have the opportunity to be involved in decisions about treatment and
care
23
C.
Provide
knowledge of the disease and medication prescribed
, pharmaceutical personnel should help client to understand disease, drug, treatment benefits, side effects and what to do if experienced, how to use, what to do if a dose is missed, duration of treatment and information’s should be both oral/written .
personnel should be empathizing,
provide information easy to understand
and free from jargon and provide pictorial representations, symbols and large prints
E. Involve
patients in decision making
, healthcare provider should adapt their consultation style so that patients are given the opportunity to be involved in the decision making process
24
f
. Simplify regimen:
reduce
polypharmacy as far as possible, use of combination products, shorter duration of treatment and providing guidance on device use e.g. inhalers)
g
. Reduce
side effects of dispensed medicines:
Prescriber should consider to selecting treatment with lower levels of side effects or concerns for long term use and address problems that could be linked with physical difficulties
h
. provide
counseling and instruction
on the usage of medicines including child resistant containers, inhalers, blister packs, small tablets difficult to handle and provide liquid formulations for the patients who have swallowing problems.
25
Refer SIMPLE acronym in the process of improving adherence
26
Key
points
Non adherence with the prescribed treatment regimen is a real problem that results in treatment failure and consequently, increased morbidity and mortality.
Patients need to be supported, not Blamed, the consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs, improving adherence also enhances patient safety.
Adherence is an important modifier of health system effectiveness, improving adherence might be the best investment for tackling chronic conditions effectively
27
Review questions
What is adherence in the treatment?
What are the reasons for non-adherence in the treatment?
28
References
Patel NC,
Crismon
ML, et al. (2005) Drug adherence: Effects of decreased visit frequency on adherence to clozapine therapy.
Pharmacotherapy. Kenya
Murphy DA,
Marelich
WD, et al. (2004) Predictors of antiretroviral adherence.
AIDS
Care.British
Osterbery
L,
Blaschke
T. (2005)
Adherence to Medication.
NEJM Sweden
Caballero MJ, et al. (2008)
Self-Reported Adherence to Treatment and Quality of Life in Mild to Moderate
Acne.
Dermatol
; British
29
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