Medication Adherence

1. Medication Adherence Hyeran Choi Northeastern University

2. Purpose of this Module • To address knowledge about medication adherence • To develop means to enhance non-adherence • To educate, raise awareness, and advocate ways to improve medication adherence among clinicians, pharmacists, and public health practitioners

3. Terms forUse of Medication • The patient’s conformance with a health care provider’s recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time • Compliance: A patient’s passive adherence of the provider’s orders • Persistence: Duration of time patients takes medication, from initiation to discontinuation of drug therapy Source: http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

4. Medication Adherence Statistics • Estimated annual excess costs in U.S. as a result of medication non-adherence: $300 billion • Number of deaths annually in U.S. due to medication non-adherence: 125,000 • Americans who report that they do not always take medications as directed: 75% • Prescriptions written but never filled: 33% • Americans with chronic illnesses and most vulnerable to non-adherence: 50% • Increased mortality among those with diabetes and heart disease who do not follow their medication regimens: 50% Source: http://betterhealth.mckesson.com/2012/07/spotlight-on-americas-costliest-health-problem/

5. Non-Adherence and Outcomes • Annual direct cost estimated $100 - $289 billions • Annual costs $2000 per patient in physician visits • High adherence to antihypertensive medications at higher odds of blood pressure control • Poor adherence to heart failure drugs at increased number of cardiovascular-related emergency room visits • Example: Non-adherence to statins in a year after hospitalization for myocardial infarction with an 12%-25% increased relative hazard for mortality Source: http://circ.ahajournals.org/content/119/23/3028.full

6. Non-AdherenceReasons Source: http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

7. Healthcare System/Team Factor • Access to care • Patient material not written in everyday language • Stress of healthcare visits • Patient’s belief or understanding • Patient’s forgetfulness • Stressful life events • Lack of immediate benefits of therapy Source: http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

8. Patient, Therapy, Condition Factors Patient Condition and Therapy Complexity of medication Frequent changes in regimen Treatment requiring certain techniques Unpleasant side effects Medications with social stigma • Physical • Psychological Source: http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

9. Economic and Social Factors Economic Social Limited English proficiency Inability/difficulty accessing pharmacy Lack of family or social support Unstable living conditions • Health Insurance • High cost of medication Source: http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

10. Healthcare Provider Factor • Communication skills • Lack of empathy • Lack of positive reinforcement • Number of medications needed per day • Types or components of medication • Amount of prescribed medications or duration of prescription Source: http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

11. SIMPLE • Atreja, et al (2005) created strategies to improve adherence under the mnemonic SIMPLE • Simplify regimen • Impart knowledge • Modify patient beliefs and behavior • Provide communication and trust • Leave the bias • Evaluate adherence Source: http://www.acpm.org/?MedAdherTT_ClinRef#Strategies

12. Patient-OrientedNon-Adherence Interventions • Behavior-related • Forgetfulness: Daily alerts, 90 days medication supplies, Automatic renewals • Clinical-Any concerns about medication • Pharmacist consultation • Cost-related • Payment assistance programs • Lower cost alternatives • Lower cost pharmacy option (ex. Home delivery) Source:http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

13. Resources for Further Information • Team Up. Pressure Down • Providers may advice patients to team up with pharmacists for better comprehension about their conditions and medications. • Available at http://www.cdc.gov/features/tupd/ • A program guide for pharmacists to improve medication adherence. • Available athttp://www.cdc.gov/dhdsp/programs/nhdsp_program/docs/Pharmacist_Guide.pdf

14. Reflection Medication non-adherence is a growing concern to our discourse community because this issue is prevalent and related to adverse outcomes and high costs of health care today. Early in this writing course, I had opportunity to research about high cost of medication. While looking for a topic for the Unit 2 project, I remembered reading an article that discussed how medication adherence reduces health care costs. This sparked my interest to research about the medication adherence for the Unit 2. Adherence to prescribed medication is integral to patient outcomes. However, consistent adherence is difficult and challenging process. To date, the use of interventions to enhance medication adherence are not common in everyday clinical practice. Healthcare providers such as pharmacists and physicians have a significant role in improving the medication adherence thus leading to the maximal outcome that patients can achieve. The goal of this project is to raise awareness regarding the importance of medication adherence, to inform and educate colleagues about various ways to improve medication adherence, thus promoting the finest and efficient health care delivery to our patients. In order to achieve the purpose of this project, I divided this PowerPoint slide into sections to address what really ismedication adherence, the prevalence of medication non-adherence, the relationship between non-adherence and outcomes, the reasons for non-adherence, and eventually interventions to advance medication adherence. Since the targeted audience is colleagues such as physicians, pharmacists, and nurses, the word was not specifically written in plain language. I also did not attempt to translate certain medical terms or information for patients or general public. In addition, various design elements such as bullet points, bold and font colors, headings, subheadings were used to convey messages clearly and easily. I also utilized parallel construction, repeating design elements consistently throughout the module. For instance, most slides begin with brief, bold headings that give insights what the slide would be about, followed by bullet points. Bullet points also mostly starts with nouns, and I tried to keep the points short, clear, and concise. Moreover, I included some visual elements such as a chart to show various non-adherence factors and pictures as well in order to make this project visually pleasing and easy to follow and understand for audiences. Furthermore, I also added medication statistics in the United States with some red bold numbers for emphasis. This statistic was intended to engage the audiences and to convey importance of this topic. Hence, this professional slide serves to provide information in a concise and professional manner. **Note: I believe that this piece would well fit into a professional portfolio. Because content and design of this project are on professional level, this project would fit nicely as part of the professional portfolio.

15. Bibliography • ACPM (American College of Preventive Medicine). Medication Adherence Clinical Reference. Retrieved from http://www.acpm.org/?MedAdherTT_ClinRef#Strategies • Better Thinking for Better Health (2012, July 9). Spotlight On: America’s Costliest Health Problem. Retrieved from http://betterhealth.mckesson.com/2012/07/spotlight-on-americas-costliest-health-problem/ • CDC (2013, March 27). Medication Adherence. Retrieved from http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf • Ho, P. Michael, Bryson, Chris L, Rumsfeld, John S. (2009, June 16). Medication Adherence: Its Importance in Cardiovascular outcomes. Retrieved from http://circ.ahajournals.org/content/119/23/3028.full