Adherence to Medications Susan E. Fleming, MN, RN Michele Wolfe, MN, ARNP Cindy Corbett, PhD, RN

Susan E. Fleming, MN, RN Michele Wolfe, MN, ARNP Cindy Corbett, PhD, RN

Learning Objectives o Describe adherence & co-morbidity o Identify WHO’s Five Dimensions to Medication Adherence o Describe self-management support strategies for overcoming barriers to medication adherence.

Patient Adherence to Medications

Adherence o Mosby’s Medical Dictionary defines adherence as “the process in which a person follows rules, guidelines, or standards, especially as patients follow a prescription and recommendations for a regimen of care”

Co-morbidity Primary disease + One or more diseases = Co-morbidity

Self Management Support o Demonstrating new skills o Praise & Feedback

Self-Management

Chronic Care Model

Global Medication Adherence is 50%

WHO’s Five Dimensions of Adherence

1. Social & Economic

o Community Support

1. Social & Economic o Economic

1. Social & Economic o Pictures – Use pictures when giving instructions o Read Back – Have the patient read back the instructions Prescription for Medication

1. Social & Economic How to make an Economic Poster from a PowerPoint Slide o Go to PowerPoint o Use Graphics and Make a Poster o Take a thumb drive or disc to a Print Shop and make a poster.

1. Social & Economic Use Pictures When Teaching

2. Health Care System o Provider-Patient Relationship

2. Health Care System o Using two-way communications and asking open ended questions fosters encouragement.

o Shared Decision Making 2. Health Care System

3. Condition Related o Chronic conditions, such as hypertension, that lack symptoms highly impact the level of adherence

o People’s belief about the benefits and risks of medications influence whether they abide by a regimen. 3. Condition Related

4. Therapy Related o Therapy-related factors include the complexity of medication regimen and unpleasant side effects.

o Dosing several times a day may contribute to non- adherence. 4. Therapy Related

o Concern about medication side effects remains a powerful barrier. 4. Therapy Related

5. Patient Related o Perception of need, medication effectiveness, and safety.

o Follow up Appointments 5. Patient Related

o Personalized education and counseling sessions delivered by telephone, intranet, or in person by trained personnel.

Conclusion

QUESTIONS AND DISCUSSION?

References o Agency for Healthcare Research and Quality. (2002). Preventing Disability in the Elderly with Chronic Disease. Retrieved May 15, 2010, from o Chronic Care Model (2010). The Chronic Care Model. Retrieved June 15, 2010, from del&s=2 del&s=2 o Goldberg, E., Dekoven, M., Schabert, V., et al. (2009). Patient Medication Adherence: The Forgotten Aspect of Biologics. Biotechnology Healthcare, o Murray, M., Morrow, D., Weiner, M., et al. (2004). A Conceptual Framework to Study Medication Adherence in Older Adults. The American Journal of Geriatric Pharmacotherapy, 2(1), 36-43

References continued. o Ruppar, T., Conn, V., & Russell, C. (2008). Medication Adherence Interventions for Older Adults: Literature Review. Research and Theory for Nursing Practice: An International Journal, 22(2) o Sherman, B., Frazee, S., Fabios, R., et al. (2009). Impact of Workplace Health Services on Adherence to Chronic Medications. The American Journal of Managed Care, 15(7), o Simpson, R. (2006). Challenges for Improving Medication Adherence. The Journal of the American Medical Association, 296(21), o World Health Organization. Adherence to Therapies: Evidence for Action. Geneva: World Health Organization, 2003

Contact Information Susan Fleming, MN, RN, PhD student Michele Wolfe, MN, RN