Medication adherence is defined as administering medications in the amount and time in which they were prescribed by the primary care physician or specialist. Similarly, it is described as the commitment that a patient has to administer their medications as prescribed. Annually, about 51% of patients with chronic conditions, such as diabetes, hypertension and kidney problems, suffer complications, sometimes fatal, as a result of not taking their medications as prescribed. These complications are mostly associated with aspects of adherence and in other instances, safety aspects in therapy.
Good medication adherence is associated with significant decreases in morbidity, mortality, and hospitalizations. However, despite the clear benefits of adherence, patients often have difficulty taking their medications as prescribed. Among the factors that have been linked to a decrease in adherence are:
- Fear of developing adverse effects or experiencing unwanted effects
- Complexity in the therapeutic regimen (polypharmacy or multiple administrations throughout the day)
- Lack of knowledge about the indication of the medicine
- Poor accessibility to prescribed treatment
- Polypharmacy (using eight or more medicines)
- Depression and social aspects, among others
There are many ways we can help our patients identify their treatment barriers and overcome them to improve their adherence. These strategies include:
–Educate the patient about their medication regimen: On many occasions, patients do not take their medications because they do not understand the need for the medication, the nature of the side effects, or the time it will take to see results. That is why, when prescribing a medication, it is important to educate you about it and provide them with the necessary tools to empower you with your treatment.
– Drug accessibility: Validate your patient’s drug coverage so that you can choose the alternatives available on your formulary and likewise, you can know in advance if the patient will need additional information in the medical prescription, so that the drug is approved. The high cost can lead to patients not bringing their medications or even rationing the doses of therapy in order to extend the days of supply. Consider the latter, especially for patients who reach the top of their health plan coverage throughout the year.
– Simplify the therapy regimen: try in each meeting, review the indications of the medications that your patient takes, he may be taking medications that are not indicated, which complicates the therapeutic regimen. Similarly, simplify the number of tablets by consolidating the treatment into one tablet formulations containing more than one active ingredient.
–Involve family or friends: Creating the habit of taking medication can take weeks, according to studies conducted in the outpatient setting. Involving family or friends in this process can help the patient in developing a greater commitment to their therapy.
Without a doubt, the health and well-being of our patients is a priority. That is why you can recommend the following tips to your patients:
– Use a pillbox that you can fill weekly.
– Recommend taking the medicines at the same time every day, this way the patient will create the habit and forget it less.
– Advise using alarms and reminder notes in places that the patient frequent during the day.
– Recommend NOT skipping any doses and emphasize the importance of not stopping taking medications on his own.
– Discuss with your patient the importance of informing the natural products or supplements you want to start. This will make it possible to validate the safety of these based on the patient’s existing conditions and other clinical parameters (e.g. renal function) or medications (drug-drug interactions).
– Finally, ask the pharmacist or pharmacy of the patient’s choice to assist you in the development of a table of medications with the hours of administration and requirements of each of them (e.g. take with food, take it on an empty stomach, among others).
Remember that better adherence to prescribed treatment will be an additional step for your patient towards a better quality of life.
Author: Dr. Cathyria M. Marrero Serra, PharmD, BCPS
References
1. Illinois, S. A., PharmD, MSLIS Freelance Medical Writer Woodstock. (2011). The Pharmacist’s Role in Medication Adherence. www.uspharmacist.com. https:// www.uspharmacist.com/article/the-pharmacists-role-in-medication-adherence
2. Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacology Toxicology. 2008 Mar;102(3):275-80. doi: 10.1111/j.1742-7843.2007.00206.x. Epub 2008 Jan 30. PMID: 18248511.
3. American Medical Association. (2015). 8 reasons patients don’t take their medications. American Medical Association. https://www.ama-assn.org/deliveringcare/patient-support-advocacy/8-reasons-patients-dont-take-their-medications
4. Florida, G. R. G., PharmD, BCPS Clinical Pharmacist Sacred Heart Hospital Pensacola, Florida Meredith Romano, PharmD, BCPS Clinical Pharmacist Sacred Heart Hospital Pensacola, Florida Brooke Crosby, PharmD PGY-1 Pharmacy Practice Resident Sacred Heart Hospital Pensacola. (2 C.E., February). Medication Adherence and the Hospital Pharmacist. Www.uspharmacist.com. https:// www.uspharmacist.com/article/medication-adherence-and-the-hospital-pharmacist