This document discusses medication adherence, which refers to patients taking medications as prescribed by healthcare providers. Around 125,000 people die each year due to failure to take or improperly take medications. The document explores differences between adherence and compliance, statistics on adherence, factors influencing adherence, and the importance of adherence. It also provides a clinical case study of a patient with low adherence and the barriers and health impacts.
1. MEDICATION ADHERENCE:
DEFINING THE PROBLEM
November 7, 2012
Marquila Ferrell & Sarah Hudson
The University of Toledo
2. Objectives
2
Define medication adherence
Explore the differences between medication
adherence and medication compliance
Identify associated statistics
Factors that contribute to medication adherence
Why medication adherence matters?
3. Introduction
3
125,000 people die a year due to failure to take
medication or taking medications improperly
Almost 6 out of 10 people are taking at least one
prescription drug
More than 1 in 3 medicine-related hospital
admissions occur due to people not properly
adhering to their medications
Script Your Future. (2012). National Consumers League.
4. What is Medication Adherence?
4
“The extent to which patients take
medications as prescribed by health care
providers.”
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England journal of medicine, 353(5), 487-
97.
5. Medication Adherence vs. Patient Compliance
5
“Compliance suggests that the patient is passively
following the doctor’s orders and that the treatment
plan is not based on a therapeutic alliance or contract
established between the patient and the physician.”
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England journal of
medicine, 353(5), 487.
6. Medication Non-Adherence
6
Intentional medication non-adherence
“Active process whereby the patient chooses
to deviate from the treatment regimen.”
Unintentional medication non-adherence
“Passive process in which the patient may be
careless or forgetful about adhering to
treatment regimen.”
Ho, P., Bryson, C., , & Rumsfeld, J. (2009). Medication adherence: Its importance in Cardiovascular Outcomes.
Circulation, 119(23), 3031.
7. Effects of Medication Non-Adherence
7
Increased hospital readmission
Increased disease progression and complications
Increased health care costs
Decreased quality of life
Patient death
8. Patient Interviews
8
“Taking my medication helps balance my
life. If I do not take it, I often get sick or
have emotional episodes.”
9. Why Don’t Patients Take Their Medicine?
9
Most Common Reported Reasons
Late Refill
10%
Clinical
Questions
15% Missed Dose
39%
High Cost
16%
Late Renewal
20%
Express Scripts (2012). Retrieved from http://lab.express-scripts.com/wp-
content/uploads/2012/07/Americas_317B_Condition.pdf
10. 5 Dimensions of Medication Adherence
10
Adult Meducation (2006). Overview of Medication Adherence. American Society on Aging and American Society
of Consultant Pharmacists Foundation.
11. Clinical Case Study
11
Primary source
48 year old African American male with low
socioeconomic status presenting myocardial infarction
and end-stage renal disease
Assessment of medication adherence behaviors
Psychological screening
Questionnaires
Post-discharge phone interview
Electronic pill bottle
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with
myocardial infarction. Frontiers In Psychology, 3:267, 1-3.
12. Post-Discharge Report
12
Measures Details Results
Barriers to adherence Asks whether Rx were filled No barriers self-reported
, and if not, reasons why
not
Morisky scale 8 item self-report 2/8 score
medication adherence scale
Modified CARDIA scale For each medication, self- 7/7 for all medications
reported # of days in
week meds were taken
Electronic pill bottle # of days pill bottle was Aspirin 6/31
opened, divided by total # Statin 3/31
of days monitored B-blocker 2/31
Clopidogrel 0/31
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with
myocardial infarction. Frontiers In Psychology, 3:267, 7.
13. Study Results
13
Limitations to medication adherence for Mr. P
Low socioeconomic status
Lived alone
Distrust in medications efficacy
Belief medications being overused
Outcomes
Hypertension poorly controlled
Intermittent chest pain
Progression of coronary artery disease concern
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-adherence in a patient with
myocardial infarction. Frontiers In Psychology, 3:267, 4.
14. Summary
14
What medication adherence is
Significance of adhering to medications
Barriers to proper medication adherence
Pharmacists and MTM services
Health outcomes and pharmacy administrators
16. Resources
16
Adult Meducation. (2006). Overview of Medication Adherence. American Society on
Aging and American Society of Consultant Pharmacists Foundation. Retrieved from
http://www.adultmeducation.com/OverviewofMedicationAdherence_4.html.
Express Scripts (2012). Retrieved from http://lab.express-scripts.com/wp-content/uploads/
2012/07/Americas_317B_Condition.pdf
Ho, P., Bryson, C., , & Rumsfeld, J. (2009). Medication adherence: its importance in
cardiovascular outcomes. Circulation, 119(23), 3028-35. Retrieved from http://
www.ncbi.nlm.nih.gov/pubmed/19528344.
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England journal of
medicine, 353(5), 487-97. Retrieved from http://www.nejm.org/doi/full/
10.1056/NEJMra050100.
Script Your Future. (2012). National Consumers League. Retrieved from http://
scriptyourfuture.org/medication-adherence/.
Ye, Siqin, Krupka, David, & Davidson, Karina. (2012). Diagnosing medication non-
adherence in a patient with myocardial infarction. Frontiers In Psychology, 3:267,
1-7. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411184/.
Editor's Notes
Patient stated he could afford his medications and foresaw no difficulties in obtaining and filling medications.Morisky scale-POOR ADHERENCEElectronic pill bottle-POOR ADHERENCE