Take as Directed: Some Stats and Facts Regarding Medication Adherence

Medication Adherence is the most important factor determining Medical Outcomes– WHO, 2003 - World Health Organization, Adherence to long term therapies: evidence for action.

Compliance Rates for “Life Saving” prescriptions is less than 50% - World Health Organization, Adherence to long term therapies: evidence for action, 2003.

22% of US Patients take less of their medications than prescribed. - CMAG Case Management Guidelines, CMSA.org.

5-20% of patients are using more than one medication, in error, from the same class - Singh R., “How a series of errors led to recurrent hypoglycemia,” Journal Of Family Practice, June 2006:Vol.55, No.6.


32 million Americans are taking three or more medications daily - CMAG Case Management Guidelines, CMSA.org.

29% of the patients stop taking their prescription medications before supplies run out or before they have completed a course of therapy - CMAG Case Management Guidelines, CMSA.org.

Approximately 125,000 deaths occur annually in the United States because of non-adherence with cardiovascular medications. - CMAG Case Management Guidelines, CMSA.org.

Only about 50% of any given patient population continues taking their medication. Of these remaining patients, about 22% take less of their medication than is prescribed. They miss or skip doses and consequently lose the maximum potential benefits of therapy. -CMAG Case Management Guidelines, CMSA.org.

"In the U.S., non-adherence affects Americans of all ages, both genders and is just as likely to involve higher-income, well-educated people as those at lower socioeconomic levels." - "Enhancing Prescription Medicine Adherence: A National Action Plan," National Council on Patient Information and Education, August 2007.

"Medication non-adherence is a problem that applies to all chronic disease states"- "Enhancing Prescription Medicine Adherence: A National Action Plan," National Council on Patient Information and Education, August 2007.


It's important to know these facts and statistics to completely understand how serious medication adherence can be. We as health care providers can have a direct impact on these statistics and increase adherence to prescription medications by spending time with the patient, carefully explaining the importance of the medication, adverse side effects and therapeutic results. We should also work to follow-up with patients to make sure that they are taking their medications as directed, that they are refilling their medications, and to identify any barriers that might exist that keep the patient from taking their medications (i.e. cost or forgetfulness).

If you are interested in reading the full version of the World Health Organization's Adherence to long term therapies: evidence for action; it can be purchased directly from WHO by clicking here.

To download the CMAG Case Management Guidelines from the Case Management Society of America, click here.

If you would like to read Enhancing Prescription Medication Adherence: A National Action Plan by the National Council on Patient Information and Education; you can download the PDF by clicking here.

Looking Within the System

Is is possible that the healthcare system itself can contribute to a lack of medication adherence? In a study of managed care organization enrollees for 3 years, individuals went without medications an average of 20.9% of the time. Findings from this study led to further research that found great variations in patient adherence among prescribing physicians. Although no explanation was offered, the findings suggested that there might be a link between patients’ adherence and the behaviors of health providers. This might be explained by a combination of a systems approach (emphasizes how the environment, including health care systems affect patients’ adherence) and the communications approach (this approach views improving provider-patient interaction and patients’ satisfaction as a way to improve adherence).

Here are some examples of Health Care Delivery Systems and Health Care Providers Can Affect Adherence:

• higher co-payment levels are associated with reduced compliance
• pharmacy-based programs, including patient education, medication dispensed using adherence aids such as custom-packaged blister packs, or regular follow-up with pharmacists can improve patient adherence
• good communication between patients and health providers
• higher patient satisfaction with their relationship with the physician will increase adherence

In a study of patient-physician interaction, two thirds of physicians did not even ask their patients any questions about barriers or side effects of their drug use! If physicians would spend a bit more time telling patients about their medications, adherence would most likely go up. There is a definite need to look within the health care system and see what works and what does not work to improve medication adherence nation-wide.

As nurses, we might be able to fill in this gap. If these findings are correct and if physicians are not meeting the educational needs of the patient, then as nurses, we can spend more time educating the patient on how to take their medications properly. We should not only see an increase in medication adherence, we might even seen an increase in patient satisfaction. Who knows, we might even be able to change the system!

See this article from the Journal of Managed Care Pharmacy to read detailed information about these studies!

Helpful Reminders for Taking Your Medications

It's easy to forget to take your medications and forgetfullness is one cause of the lack of medication adherence. Below are some tips for remembering to take medications. This came from an article regarding thyroid medication, but these helpful tips can be used in any situation and might prove to be helpful teaching tools for patients who have a hard time remembering to take their drugs regularly.

Helpful tips for remembering to take medications:

1. Write it in your datebook. Write it in a special color that is hard to miss.

2. Since you're reading this on a computer, consider putting your reminder in your computer's scheduling program. Some programs allow you to set a regular daily "appointment" at a particular time. Some even have an alarm function that you can set.

3.Put a message on your computer's screen saver.

4. Keep your pill container right on top of your alarm clock, so you can remember to take your medicine first thing in the morning. (But be careful to keep your medications away from children.)

5. Put a note wherever you'll notice it every day - on the refrigerator, on your coffee maker, on your toothbrush, on your bathroom vanity mirror, etc.

6. Take your medicine the same time every day, so it becomes a habit.

7. Hire a calling service to give you a daily "wakeup" call to remind you to take your pill. If you have a home voicemail system such as "AnswerCall," you can even program a daily reminder call at the same time each day. You can even sign up online for a free service, like "Mr Wakeup," which will make free reminder calls to you.

8. Use a pill sorter, or a device known as a "dosette," which has compartments for different days, or even different times of the day. See the picture at the top of this post for an example of a "dosette".

9. Get a special device to remind you to take your pill. Epill.com offers a variety of devices, including medication computers, vibrating watches, automatic dispensers, beeprs, and other alarms that can help keep you on schedule for taking your medication.

10. Enlist the aid of a family member or friend to help. Sometimes, just a few weeks of friendly reminders can help you get into the habit of taking your medicine at the right time every day.

Nonadherence

Medication non-adherence can lead to many things such as not creating the desired effect and toxicity depending on when the medication was supposed to be taken and if there was supposed to be food, drink or the like. According to the American Society on Aging and American Society of Consultant Pharmacists Foundation "Medication nonadherence accounts for more than 10% of older adult hospital admissions, nearly one-fourth of nursing home admissions, and 20% of preventable adverse drug events among older persons in the ambulatory setting. It is estimated that medication nonadherence results in 125,000 deaths annually, and costs the US health care system $100 billion per year." These numbers are serious! When talking about something that could be solved just by taking the medication properly that was prescribed to them these people could possibly spare themselves from the nursing home, high hospital bills, and even death! There are 4,175 reported deaths in all of the Operation Iraqi Freedom campaigns combined; this means that there are more people dying per year because they didn't take thier medication as people that have died in combat over 6 years! Grim numbers for something I think is preventable. If someone that you know forgets to take medicine GET THEM A REMINDER!!!
http://www.epill.com/bysku.html


-DRS

Visual Aide: A Video on Medication Adherence

Check out this video for a great over-view of medication adherence and why people might become non-compliant:
http://www.youtube.com/watch?v=Gn1eGtf2ZSg

Medication Adherence: To Comply or Not to Comply

At some point or another, we've all been guilty of not taking our medications as directed. Have you ever given up on that bottle of antibiotics because your symptoms were gone, or how about taking an extra Tylenol or two because your headache was REALLY bad? These are both examples of non-adherence or non-compliance to medications. If one of these situations sounds familiar you are not alone. It is estimated that 50% of people taking medications do not adhere to taking them as directed.

Now imagine you have a life-threatening chronic condition that is only kept in-check by a strict medication regime. Imagine that in order to treat this life-threatening condition you have to take multiple medications, maybe up to 15 a day. Staying compliant just got a little more complicated. It's easy to see how people can fall behind on taking their drugs as directed.

Some of the top reasons why people don't take their drugs (not necessarily in order):
1. They forget.
2. They never get them filled or refilled.
3. They don't like the side effects.
4. They don't see the effects.
5. They're not sure of why they are taking the medication in the first place.
6. They can't open the containers, swallow the drug, read the instructions, etc.
7. They can't afford the drug.
8. The regimen is too complicated.

It is important that we as health professionals work hard to make sure our patients adhere to their medications. Many of the reasons people stop taking their drugs are easily resolved through education and a little extra effort on our part. Throughout this blog, we'll be exploring more reasons why people don't adhere to their medications and how we as health professionals can assist in helping people maintain their medication therapies.

For a good resource on managing medications visit the National Council for Patient Information and Education.