Patient’s Medication Experience 1

Notes One of the important variables that if succeed it will affect in providing good pharmaceutical care. It is an important issue that should be performed in the patient’s assessment. i.e Therapeutic relationship Understanding patient's medication experience ---- Pharmacotherapy workup. 2

Notes For every patient As the Physician learned how to understand the patient view on his illness (Descrition of disease). The Pharmaceutical care practitioner should learn how to understand the patient perception and behavior of his medication (Medication experience). 3

Definition The summation of all events a patient has in his lifetime that involve drug therapy. (Patient Personal Experience with Medications). (Unique experinece) 4

Short vs. Extensive Short (little) medication experience - Short period of medication use (little to be ill). - Young patient. - Patient with few medications. Extensive medication experience - patients who have taken numerous medications. 5

Affected by …. Patient’s preference Patient’s attitude Patient’s tradition. Patient’s religion. Patient’s culture. What he heard or learnt from others. 6

So… all of these will affect Whether the patient takes his medication or not! How the patient uses his medication! Whether the patient believes the medication will be effective ! Whether the patient believes the medication will be harmful! Patient’ preference, attitude, tradition, religion, and culture will affect his confidence in himself and how he can help himself to improve his quality of life. 7

Positive vs. Negative Medication Experience If a patient has negative medication experience - This may affect his outcome. - This may affect his expectation on your ability to help him. So your role is to recognize and directly address patients with negative experience. 8

Example on Negative Medication Experience Patient may prefer not to take medications at work - Greatly affect the compliance and outcomes. Patient’s experience (ex. Not to take a medication) is strongly affected by friends or family members. Patient from a religious point of view belief not to use a contraceptive. Patient rely on traditional medicine to maintain health and only may use medication for acute or severe illness. 9

Consists of …. 1)Understanding the patient’s description of the experience he has with the medications. 2)Comprehensive medication history. 3)Complete record of the patient’s current medications and associated medical conditions. 10

1) Understanding the patient’s description of the experience he has with the medications The early step in the assessment. Practitioner should encourage patient to describe medication experience. 11

1) Understanding the patient’s description of the experience he has with the medications A.What is the patient’s general attitude toward taking medication The summation of life events that affect his belief, concern, understanding and preference. Negative attitude - Drugs not work - Drugs cause problems. - Prefer not to take. Positive attitude - the patient said there must be a drug that can solve my problem. 12

1) Understanding the patient’s description of the experience he has with the medications A.What is the patient’s general attitude toward taking medication Ex. if a patient is using a herbal product - Less +ve perception on the medication safety. - More +ve perception on the herbal effectiveness. 13

1) Understanding the patient’s description of the experience he has with the medications B.What does a patient want / expect from his therapy. You should ask them what they expect or want ….. As some patients Find it difficult to describe what they want. Hesitate to share what he wants with a person with whom he doesnot establish a good relationship. Thought that what they want is not important for practitioners. Thought that the practitioner is too busy with other issues to deal with other than what patient’s want. 14

1) Understanding the patient’s description of the experience he has with the medications B.What does a patient want / expect from his therapy. Be sure that sometimes what the patient wants is not what he actually needs. 15

1) Understanding the patient’s description of the experience he has with the medications C. Patient’s concern Risk of taking medications. Adverse effects experienced. Confusion on how to use the medications. Confusion on why the medication is used for. - Afraid from using a medication …. 16

1) Understanding the patient’s description of the experience he has with the medications D. Patient’s understanding of drug therapy. Understanding why the medication is used for. Name of medications. Dose and dosage schedule. Clinical and lab test measures needed. -- this will determine how much education the patient needs from the practitioner. 17

1) Understanding the patient’s description of the experience he has with the medications E. Culture, ethical and religious issue Affect the patient’s attitude and belief about the use / appropriateness of medication. Affect the patient’s attitude and belief about the efficacy of medication. 18

1) Understanding the patient’s description of the experience he has with the medications F. Patient’s medication taking behavior Describe the patient’s makes and acts related to the use of drug product and dosage regimen. Depends on all the previous points. - Whether the patient chooses to take medication. - How the patient takes the medications. - If he choose to refill. - If he compliant to take the medication in appropriate way. 19

2) Medication history Main aims Recording the medications that are taken in the past. Recording the effectiveness of the previous medications - can direct future drug selection. Recording the safety of the previous medications - serve as warning to avoid re-exposing the patient to harm. 20

2) Medication history List of components of medication history Immunization records. History and quantification of social drug use. Medication allergy and characteristics of allergic response. Adverse drug reactions. Health alerts and/or special needs for patients. Historical account for relevant medication use. 21

2) Medication history Immunization records Includes childhood and adult vaccinations. Immunization record is important to be kept by patients - usually used for travel, school, emergency care. 22

2) Medication history History and quantification of social drug use. Include - Tobacco. - Caffeine. - Alcohol - Drug of abuse. - Herbal remedies. This is important as these may affect dug absorption, distribution, metabolism, and excretion. 23

2) Medication history Medication allergy and characteristics of allergic response Definition: unfavorable physiological response to an allergen to which the patient develops an immune response and through the release of chemical mediators (histamine, complement, cytokines, … ). The allergic symptoms - urticaria, eczema, dyspnea, bronchospasm, rhinitis, ………..., anaphylaxis. 24

2) Medication history Medication allergy and characteristics of allergic response Medication allergy recording should include: - To which agent the allergic response occurs. - the types/ symptoms of allergic response. - the time of allergic response Should differentiate between allergic response and ADR. 25

2) Medication history Adverse drug reaction Definition: harmful, undesirable and unintended response that occurs after drug administration at usual dosage used in treatment, prevention or diagnosis. Type A, B, C, D, E, F, G. 26

2) Medication history Adverse drug reaction Adverse drug reaction recording should include - To which possible agent the adverse reaction occurs. - The types/ symptoms of ADR. - The time of ADR. - The resolution of ADR. 27

2) Medication history Alerts and special needs Impaired hearing or loss. Problems with walking up stairs. Require oxygen therapy. Language barrier. Special need while taking the medications. Special alerts in genetic variations (ex. G6PD deficiency). 28

2) Medication history History of relevent medication use Include the medications that affect the current therapy decision. - Why he takes this drug. - The drug product (name, dosage regimen) - Duration of treatment. Within 6 months duration. Can direct future drug selection. Serve as warning to avoid re-exposing the patient to harm 29

3) The current medication record All the patient’s current medical condition or illness and how they are being managed with drug therapy. Current medication information recorded include: - Indication. - Drug product. - Dosage regimen. - Duration of treatment. - Clinical results to date. 30

3) The current medication record Indication Clinical reason why the patient is taking the medication. - For treatment of a diagnosed disease. - Before diagnosis. - Prevent a medical condition. - Relief sigs and symptoms. Classify the medications used by their indication. Can help to prevent DRP. 31

3) The current medication record Drug product It is noted by generic or trade name. Sometimes the name of manufacturer is needed. 32

3) The current medication record Dosage regimen Dose Strength Dosage Frequency and Dosing interval Duration of treatment 33

3) The current medication record Dosage regimen Dose: amount of active ingredient that the patient takes or applies each time he takes the medications. Strength: how much active ingredient is contained in the dosage form (mg, mg/ml, readon,. …) Dosage: total amount of drug the patient takes over a given period of time. Dosing interval: time between the consecutive doses Duration of therapy: total time the patient has taken the medication. 34

3) The current medication record Start date: - Assessing the possibility of an allergic reaction or ADR. - Assessing if a certain drug has enough time to produce the desired response. - Assessing treatment failure. 35

3) The current medication record Response The patient’s response to a drug therapy should be evaluated in relation to the desired goal of therapy. Response - Improve - Stable - Partially improve. - Worsened. - Resolved - Failed 36 +ve or –ve response