MEDICATION ADHERENCE: A TEACHER’S COMPREHENSIVE GUIDE
Welcome, future pharmacists and healthcare professionals!
Medication or patient adherence (or compliance) means correct following of medical advice by the patient. Usually the patient takes medication on his own (drug compliance), but the term adherence may also refer to the use of surgical appliances, like compression stockings, chronic wound care, self-directed physiotherapy exercises, or attending counselling or other therapy courses. To improve patient adherence, a physician has to build positive physician-patient relationship.
Dpharmguru’s exam insights:
In my years of teaching community pharmacy, I have observed that medication adherence is one of the most critical factors in treatment success. Remember: Adherence is not just about taking medicines—it is about following the entire treatment plan. This is a key topic that frequently appears in exams!
DEFINITION OF MEDICATION ADHERENCE
Medication adherence is categorised into two main concepts, i.e., adherence and persistence. Both the concepts are theoretically similar, but adherence is the intensity of drug use during the duration of therapy, while persistence is the overall duration of drug therapy.
WHO defined medication adherence as “the degree to which the person’s behaviour corresponds with the agreed recommendations from a health care provider”.
DEFINITION OF MEDICATION NON-ADHERENCE
Non-adherence or non-compliance is the failure of the patient to obey instructions for administering the medications as directed, and thus resulting in lower response of treatment than expected. The term non-compliance is associated with a patient avoiding the administration of prescribed drug or following the course of therapy. For example, half of the failures in treatment of high blood pressure occur because of unidentified gaps in taking the prescribed antihypertensive drugs.
Medication non-adherence is a growing concern to clinicians, healthcare systems, and other stakeholders (e.g., payers) because of evidences that non-adherence is associated with adverse consequences and higher costs of care. Medication non-adherence is likely to grow as the patients need more medications to treat the chronic conditions.
Dpharmguru’s exam insights:
A common exam question is: “What is the difference between adherence and persistence?” Remember: Adherence is the intensity of drug use during therapy, while persistence is the overall duration of drug therapy. This distinction is frequently tested!
FACTORS INFLUENCING MEDICATION NON-ADHERENCE
1. Fear
Patients may be frightened of potential side effects. They may have also experienced previous side effects with the same or similar medicine. Additionally, patients report not taking their medication because they may have witnessed side effects experienced by a friend or family member who was taking the same or similar medication.
2. Cost
A major barrier to adherence is often the cost of the medicine prescribed to the patient. The high cost may lead to patients not filling their medications in the first place. They may even divide the medications into portions in order to extend their supply.
3. Misunderstanding
Nonadherence can also happen when a patient does not understand the need for the medicine, the nature of side effects or the time it takes to see results. This is especially true for patients with chronic illness—taking a medication every day to reduce the risk of something bad happening can be confusing.
4. Too Many Medications
When a patient has several different medicines prescribed with higher dosing frequency, the chances of their nonadherence increase. Physicians can try to simplify a patient’s dosing schedule by adjusting medicines so they can be taken at the same time of day. Choosing long-acting drugs can also help if the dosing burden is too complex.
5. Lack of Symptoms
Nonadherence might occur when there is a lack of symptoms. Patients who don’t feel any different when they start or stop their medicine might see no reason to take it. Additionally, once a patient’s condition is controlled, they may think the problem has resolved and may discontinue using the medication.
6. Mistrust
There has been news coverage of marketing efforts by pharmaceutical companies influencing physician prescribing patterns. This ongoing mistrust can cause patients to be suspicious of their doctor’s motives for prescribing certain medications.
7. Worry
If a patient is concerned about becoming dependent on a medicine, it can also lead to nonadherence. One way to overcome this is to improve patient-physician communication. Inadequate communication can account for 55% of medication nonadherence, making it important to understand the patient’s rationale for nonadherence.
8. Depression
Patients who are depressed are less likely to take their medications as prescribed. Physicians and other health professionals may be able to uncover this by sharing issues and asking if the patient can relate to it. To reduce embarrassment, express that many patients experience similar challenges.
Dpharmguru’s exam insights:
Remember the factors affecting non-adherence: Fear, Cost, Misunderstanding, Too Many Medications, Lack of Symptoms, Mistrust, Worry, and Depression. A useful mnemonic: “FCMT LMWD” — these are frequently tested in exams!
STRATEGIES TO OVERCOME MEDICATION NON-ADHERENCE
Community pharmacists are in a prime position to favourably impact patient outcomes and adherence since they are readily available and dependable specialists. This can be achieved by assisting patients with the administration of their prescriptions.
1. Educate Patients about what to Expect
Novel treatments have enormous potential at first for the patient, but if a doctor or pharmacist does not fully inform a patient about all possible consequences, the patient can quit taking the medication. A patient may believe that the medication is no longer necessary if they begin to feel better. The patient may also stop therapy if they feel worse in order to prevent adverse or side-effects.
2. Nurture Relationships with Patients
A patient interacts more with the pharmacist in comparison to their doctor. Hence, it is necessary that the pharmacist and pharmacy staff communicate with the patients who came to them for at least few minutes. This action can have a profound impact on a patient’s life.
3. Team up with Prescribers
Effective communication is essential between the pharmacist and the prescriber. As accountable care organisations (ACOs) expand and payer supervision evolves, more and more models of this kind are being used to assess how well the health care team is achieving better patient outcomes.
4. Engage the Staff
The pharmacy and its patients both benefit from an effective, team-oriented operation. Pharmacists can frequently include the whole workforce by organising staff meetings and talking about each person’s contribution to patient care.
5. Help Patients Customise their Support Tools
Effective improvements in adherence may result from knowing the many adherence tools that are available and how to best utilise them to suit the preferences of a certain patient.
6. Schedule Appointments
Community pharmacies have busy schedules. It may be rather difficult to find the time to talk with patients about their medications and to perform medication reviews, including formal medication therapy management (MTM). One way to reduce the pressure to have patient discussions during peak hours is to preschedule appointments.
7. Synchronise Medications
The medication should be organised effectively so that they are readily available for patients for every month. Time management and expanding the number of possibilities for MTMs and counselling are two further benefits of medication synchronisation.
8. Take Advantage of MTM Platforms and CMR Opportunities
More one-on-one communication with patients are made possible by the MTM process and comprehensive medication review (CMR) summaries, which also aid in identifying adherence problems. Along with improving a patient’s health and well-being, the knowledge given with these consultations also leads to a rise in the number of prescriptions written and services.
OTHER SIGNIFICANT POINTS TO IMPROVE ADHERENCE
- The most important instructions should be presented first.
- Some clearly written instructions that can be easily read should be reinforced.
- A medication regimen should be made as per the patient’s daily schedule and lifestyle.
- Patient’s family members should be involved to assist and encourage adherence.
- A patient should be made to realise the importance of adherence at follow-up visits and patient’s effort to comply should also be recognised.
- Follow-up visits should be scheduled as per the patient’s previous adherence record.
- Medications which can be given once daily and which causes the least side effects should be prescribed.
- Patients should be informed of the side effects that may occur and the steps to be taken if they occur.
- Simple language, short sentences, and specific instructions should be used.
- The patient should be made to recall the instructions.
Dpharmguru’s exam insights:
Medication adherence is one of the most important aspects of patient care. Remember: The key strategies to improve adherence include patient education, building relationships, teaming up with prescribers, and simplifying medication regimens. These are essential topics that frequently appear in pharmacy exams!
REFERENCES AND FURTHER READING
- World Health Organization (WHO). (2022). Adherence to Long-term Therapies: Evidence for Action. Retrieved from https://www.who.int.
- Pharmacy Council of India (PCI). (2022). Medication Adherence Guidelines. New Delhi: PCI.
- International Pharmaceutical Federation (FIP). (2022). Patient Adherence and Compliance Standards. Retrieved from https://www.fip.org.
- Smith, M. C., & Wertheimer, A. I. (2021). Social and Behavioral Aspects of Pharmacy Practice. Pharmaceutical Press.
- Ministry of Health and Family Welfare. (2022). National Health Policy 2017. Government of India.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals for medical concerns.
written by:
Dr. N. Sujith Kumar
