SCRIPT: adherence

Question 1

Oxybutynin may cause what side effects?

Answer 1

Antimuscarinic.

• Urinary retention (used to treat OAB)
• Constipation
• Dry eyes and dry mouth/throat
• Cognitive impairment (may result in poor medication adherence)

Question 2

Define.

a) Adherence
b) Compliance
c) Concordance

Answer 2

a) The extent to which the patient’s behaviour matches agreed (shared) recommendations from the prescriber
b) The extent to which the patient’s behaviour matches the prescriber’s recommendations (not shared - didactic)
c) The belief that patient and prescriber must come to an agreement on healthcare decision. This influences medicines taking behaviours

Question 3

Reasons for non-adherence (WHO).

Answer 3

• Social/economic factors (e.g. age, gender, an inability to pay for medicines)
• Health system/health care team (HCT) factors (e.g. the poor quality of instructions provided to the patient)
• Therapy-related factors (e.g. adverse effects of medicines, complexity of drug regimens)
• Patient-related factors (e.g. patient disagreement with the necessity for treatment, low self-esteem)
• Condition-related factors (e.g. dysphagia in myasthenia gravis)

Question 4

Two types of non-adherence

Answer 4

• Intentional non-adherence: the patient makes a conscious decision not to follow treatment recommendations.
• Unintentional non-adherence: the patient wants to follow the treatment instructions but is prevented from doing so by certain factors.

Question 5

What information to provide patient when prescribing a medication?

Answer 5

• What the medicine is and how to take it.
• The likely benefits of treatment.
• Any adverse effects and the likelihood of these occurring.
• What to do should any adverse effects occur (this is particularly important in instances where immediate cessation of medicine-taking could result in harm to the patient e.g. beta-blockers, MAOIs).
• What to do if they miss a dose.
• Expected duration of treatment (will another prescription be needed?)

Question 6

Interventions to improve adherence

Answer 6

• Medication: simplify regimen (eg. twice daily to once daily), change drug, blister packs/Nomads
• Rewards for success
• Monitoring: close follow-up, manual telephone follow-up, supervised self-monitoring, reminders
• Therapy: counselling, family therapy, couple-focused therapy, psychological therapy, crisis intervention

Question 7

Help with prescription costs

Answer 7

Free prescriptions.

• Age < 18 (in full time education) or > 60
• Pregnancy and up to 12 months post-partum
• Certain medical conditions
• NHS inpatient
• Unemployed

Prescription Pre-Payment Certificates (PPC):
- Eligible if having to pay for 3 medicines over 3 months or 12 in 12 months (but who do not get free prescriptions)

NHS Low Income Scheme
- HC1, HC2 or HC3 forms