Fast Facts: Medication Adherence

M. Koo, H.N. Young, P. Aslani

Description

Helping your patients to use their medications safely and appropriately is a critical aspect of clinical practice, but it can be challenging. The published literature on the topic of adherence is vast, and constantly growing and evolving. It is not feasible, nor necessarily helpful, to comprehensively summarize all the available evidence. Instead, this book aims to provide all health professionals with a succinct and handy resource on medication adherence. Importantly, the book focuses on practical information that can inform, and be applied in, day-to-day clinical practice. Table of Contents: • Terminology and definitions • Epidemiology • Identifying non-adherence • Interventions to support adherence

Sujets

• Médecine
• Médecine de laboratoire
• Pharmacology
• Medical

Informations

• Publié par: S. Karger AG
• Date de parution: 03 novembre 2021
• Nombre de lectures: 0
• EAN13: 9783318069938
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Fast Facts: Medication Adherence
First published 2021
Text 2021 Parisa Aslani, Henry N Young, Michelle Koo
2021 in this edition S. Karger Publishers Ltd
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The rights of Parisa Aslani, Henry N Young and Michelle Koo to be identified as the authors of this work have been asserted in accordance with the Copyright, Designs Patents Act 1988 Sections 77 and 78.
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A CIP record for this title is available from the British Library.
ISBN 978-3-318-06992-1
Aslani, P (Parisa)
Fast Facts: Medication Adherence/
Parisa Aslani, Henry N Young, Michelle Koo
Medical illustrations by Graeme Chambers, Belfast, UK.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
Contents
Introduction
Terminology and definitions
Epidemiology
Identifying non-adherence
Interventions to support adherence
Useful resources
Index
Introduction
Hippocrates, widely considered as the Father of Medicine , told physicians to keep a watch on the faults of the patients, which often make them lie about the taking of things prescribed. For through not taking disagreeable drinks, purgative or other, they sometimes die. 1 While we have made great advances in medicine and in our understanding of the health professional-patient relationship, it seems that medication adherence, or lack thereof, is an issue that transcends time.
At the start of the 21st century, the World Health Organization (WHO) described the issue of non-adherence to treatment by patients with chronic conditions as a worldwide problem of striking magnitude . 2 In 2017, a New York Times article stated that there is an out-of-control [medication-related] epidemic in the United States that costs more and affects more people than any disease Americans currently worry about. It s called non-adherence to prescribed medications 3

Poor adherence to treatment of chronic diseases is a worldwide problem of striking magnitude.
World Health Organization 2
In developed countries, adherence among patients with chronic conditions averages only 50%. 2 , 4 - 6 In less-developed nations, this is expected to be even lower given the paucity of health resources and the inequities in access to healthcare. 2 , 7
Poor adherence can result in major clinical and economic consequences. 2 The clinical consequences depend on the condition, the efficacy and pharmacological properties of the medication and the extent of non-adherence. 7 Fundamentally, as stated by former Surgeon General of the USA C. Everett Koop: Drugs don t work in patients who don t take them. Good adherence is intrinsically linked to the effectiveness of a medication, so much so that the WHO has echoed the statement by Haynes et al. that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments. 2 , 5

Drugs don t work in patients who don t take them.
C. Everett Koop, former Surgeon General of the USA
The economic consequences associated with poor adherence stem from the direct costs of not using a medication properly, including wasted medications, side effects and unintended consequences necessitating further treatment, and additional or substitute medications and healthcare utilization. Indirect costs include increased disability or absenteeism and reduced productivity. 7 - 9 Globally, non-adherence is estimated to cost $USD269 billion annually - approximately 4.6% of the world s total health expenditure. 10
So, is there a solution to this issue? What is defined as good adherence in the first place? What contributes to non-adherence? What is the role of the health professional? Do interventions to improve adherence actually work? This book answers these questions and more.
Helping your patients to use their medications safely and appropriately is a critical aspect of clinical practice, but it can be challenging. The published literature on the topic of adherence is vast, and constantly growing and evolving. It is not feasible, nor necessarily helpful, to comprehensively summarize all the available evidence. Instead, this book aims to provide all health professionals with a succinct and handy resource on medication adherence. Importantly, the book focuses on practical information that can inform, and be applied in, day-to-day clinical practice.

References
1 . Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304-14.
2 . WHO. Adherence to Long-Term Therapies: Evidence for Action . World Health Organization, 2003. https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf , last accessed 7 June 2021.
3 . Brody JE. The cost of not taking your medicine. The New York Times 2017;17 April. www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html , last accessed 7 June 2021.
4 . Sackett DL, Haynes RB, Gibson ES et al. Patient compliance with antihypertensive regimens. Patient Couns Health Educ 1978;1:18-21.
5 . Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev 2002;2:CD000011.
6 . Nieuwlaat R, Wilczynski N, Navarro T et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014;11:CD000011.
7 . FIP. Use of Medicines by the Elderly. The Role of Pharmacy in Promoting Adherence . International Pharmaceutical Federation, 2018. www.fip.org/file/1342 , last accessed 7 June 2021.
8 . Cutler RL, Fernandez-Llimos F, Frommer M et al. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open 2018;8:e016982.
9 . Iuga A, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy 2014;7:35-44.
10 . Aitken M, Gorokhovich L. Advancing the Responsible Use of Medicines: Applying the Levers for Change . IMS Institute for Healthcare Informatics, 2012. papers.ssrn.com/sol3/papers.cfm?abstract_id=2222541 , last accessed 7 June 2021.
1
Terminology and definitions
Compliance
Where it began. Compliance was a term coined in the 1970s. It is defined as: The extent to which a patient s behavior (in terms of taking or using medications, following diets or executing other lifestyle changes) coincides with the clinical prescription. 1 Despite its widespread use in the literature, the term compliance has been the subject of much debate and controversy, mainly because of the implied subservient status of the patient compared with the prescriber and the inferred passive obedience to the prescriber s instructions. 2
From compliance to adherence . Given the negative connotations and paternalistic undertones of the term compliance , the term adherence was introduced in the 1990s and has since gained widespread acceptance.
Importantly, strong emphasis was placed on the need to differentiate adherence from compliance. Adherence requires the patient s agreement to the recommendations. It focuses on cooperation rather than obedience.

Patients should be active partners with health professionals in their own care and good communication between patient and health professional is a must for an effective clinical practice.
World Health Organization 3
What about concordance ?
Concordance is another term that was introduced in the 1990s; however, it is not the focus of this book. It is briefly mentioned here to clarify that it is not synonymous with compliance or adherence , despite being mistakenly used in the literature to refer to compliance and adherence. It should be noted that compliance and adherence refer to the medication-taking behavior of the patient, while concordance refers to the nature of the interaction between the health professional and the patient. 4
Adherence
The World Health Organization defines adherence as: The extent to which a person s behavior - taking medication, following a diet and/or executing lifestyle changes - corresponds with agreed recommendations from a healthcare provider. 3
Adherence to medications consists of three components: initiation, implementation and discontinuation. 2
Initiation is when the patient takes the first dose of a prescribed medication. It is an inherently discontinuous action, that is, a one-off event.
Implementation is the extent to which a patient s actual dosing corresponds to the prescribed dosing regimen, from initiation until the last dose. It is a continuous action.
Discontinuation is when the patient stops taking or using the prescribed medication, for whatever reason(s). Like initiation, this is a one-off event.
Adherence is understood to be a multidimensional construct determined by several factors involving the patient - including their understanding, beliefs and socioeconomic circumstances - as well as other factors such as their medical condition, the treatment, and the wider healthcare system and team involved in looking after the patient. It is the interplay of these factors that ultimately determines a patient s