Adherence

Question 1

What is adherence?

Answer 1

• Compliance: “do as I say”
• Adherence: “do as we agreed”
• Therapeutic Alliance: “what can we both do to make this work”

Question 2

Defining Adherence

Answer 2

• The extent to which a person takes medications as prescribed: correct dose, time and duration
• The extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care provider

No. of Pills Taken in TimeX / No. of Pills Prescribed for TimeX (*100) >= 80%

Question 3

Assessing Adherence

Answer 3

• Patient Interview
o Be non-judgmental
o Be empathetic
o Give permission to be honest
o Ask about most immediate past
o Ask appropriate questions! (open-ended)
- What medications do you take?
- What is the dose and how often do you take it?
- How are your medications helping you?
- What side effects/concerns do you have about your meds?
- How many times have you missed a dose in the last week?
- What do you use to help you remember your meds?
- What causes you to miss doses?
- What regimen is easiest for you to adhere to?

Question 4

Assessing Adherence Cont.

Answer 4

• Review medication usage patterns 
- Counts of unused “pills”
- Timely pharmacy refill records
- Diaries
- Electronic monitoring devices
• Assess patient 
- BP
- HR
- Weight
- Self-reported symptoms
• Biologic assays: labs, drug levels

Question 5

Types of Adherence Barriers

Answer 5

• Patient: attitude or understanding (educational + psychosocial support)
• Medication regimen (clinical support)
• Provider or system issues (practical support)

Question 6

Provider or System Barriers

Answer 6

• Time to counsel and develop interpersonal relationships
• Private space for counseling
• Patient access to care and medications
- Cost
- Insurance coverage
- Transportation
• Information sharing across providers
- Limited access to the patient’s health history

Question 7

Patient Barriers: Health Literacy

Answer 7

Capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
- A person being able to understand and take the right action to make good health choices

Question 8

Addressing Patient Barriers

Answer 8

• Counsel with a collaborative approach
• Provide verbal and written education 
- Lay/plain language
- Highlight the most important points first
- Focus on actions
- Review administration techniques 
- Provide adherence tools
• Teachback
• Provide resources for follow-up

Question 9

Types of Treatment Barriers + Solution

Answer 9

• Number of medications (avoid unnecessary meds, pick the best strength)
• Dosing frequency (use long acting agents)
• Duration of therapy (evaluate need to continue)
• Side effects (educate/provide tools)
• Intrusion on lifestyle (link to daily activities, minimize med #/freq, provide dosing sched)
• Storage requirements
• Timing with meals
• Drug availability (sufficient quantity/refills, refill reminders)
• Cost (cost saving programs, changes in insurance)

Question 10

If All Else Fails… Try, Try Again!

Answer 10

• Increase the intensity of clinical follow-up
• Shorten the follow-up interval
• Recruit additional healthcare-team members 
– Mental health
– Chemical dependency counselor
– Social worker or case manager
• Involve family and friends 
• Consider DOT programs

Question 11

Adherence Devices

Answer 11

• Medication Lists: MedActionPlan, Universal Med Form (ISMP)
• Pill boxes
• Alarms
• Free apps: MyMedSched, MediSafe, RoundHealth, Dosecast, iPharmacy, MyMeds, Pill Reminder, RxmindMe