1. PATIENT MEDICATION ADHERENCE

2. What you need to learn? Definition of patient medication adherence
Consequences of patient non adherence
Types of non adherence
Causes for non adherence
How to measure medication non adherence
Methods to improve adherence

3. Patient medication compliance/adherence (الامتثال / الالتزام)
Usually refers to whether patients take their medications as prescribed
Main factor that determines treatment success
Compliance-obeys to take medicine on physician advice
Adherence: physician-patient collaboration (تعاون)
“The extent to which a person’s behavior corresponds to the agreed recommendations from a health care provider”

4. Types of non adherence:
Primary : prescription written by physician but not filled/dispensed
Secondary: patient decide to stop taking medicine without physicians advice
Tertiary-medications are not taken as prescribed.
Intentional (مقصود )-patient decides not to take medication
Unintentional (مقصود... )- patient may be careless or forgotten doctors advice

5. Consequences (العواقب) of non compliance:
increased mortality
low quality of life
disease progression
hospital admissions
increased medical and non medical cost
waste of medication

6. Medication adherence is very important in:
Chronic diseases
Diseases where serum drug concentration should be maintained-antiepileptics
Diseases which affects the health of public
Replacement therapy-insulin

7. Reasons for noncompliance
There is usually no single reason for medication nonadherence-multifactorial.
WHO divides it to five:

8. Therapy related factors
Complexity of medication regimen- number of drugs,
dosage frequency
Type of dosage form- large oral, MDI
Previous treatment failures- heart problems
Duration of therapy- tuberculosis, RA
Occurrence of side effects – aspirin ulcer
Problems with handling of medicines-
child resistant, transportation

9. Patient related factors
Physical impairments
Cognitive (المعرفي )
Vision
Hearing
Psychological/Behavioral
Anger, stress, anxiety
Low self efficacy(انخفاض الكفاءة الذاتية )
Substance abuse (تعاطي المخدرات )

10. Condition-Related Factors
Asymptomatic chronic diseases
High blood pressure
High cholesterol
Osteoporosis (هشاشة العظام)
Mental health disorders- denial of illness
Mood disorders
Depression
Bipolar
Dementia
Psychosis

11. Health System-Related Factors
Quality of provider-patient relationship- lack of confidence
Level & quality of communication-inadequate patient information
Access to healthcare
Physical
Cost
Ease of scheduling appointments- ability to get medicines

12. Social/Economic-Related Factors
Low literacy (محو الأمية منخفضة )
Lack of health insurance
Cost of medications
Burdensome work schedules
Poor social support- family problems
Cultural beliefs and attitudes
incorrect information from other sources

13. Methods for measuring adherence:
Direct methods
directly observed therapy- TB
measurement of level of medicine/metabolite in blood -antiepileptics
Indirect methods
Patient questionnaires/self reports
Pill counts
Patient diaries
Electronic monitors
Clinical outcomes

14. Measures to improve medication adherence
Education of the health care workers
Labeling and packaging
Oral/written instructions/audio-visual
materials to patients/ family members
Provide proper information about their
illness and treatment and address misconceptions
(المفاهيم الخاطئة )
Tailoring (الخياطة )the regimen to patients convenience-match it with normal daily routine

15. Sustained release (الافراز المتواصل )and long acting medication decreases the frequency
Transdermal and depot preparations improve compliance
Simplification of medication regimen-based on the patient characteristics
Review the prescription –reduce frequency and multiple drug therapy where possible-fixed combinations/polypills

16. Communicating with the patient-counselling
Address the key information about the drugs (what, why, when, how, and how long)
Inform the common side effects and those that patient should necessarily know
Medication adherence improving aids(medication diaries, pillbox, medication calendar, alarms, telephone/mail,unit dose dispensing )

17. Pillbox

18. Pill dispenser

19. Epill

20. Blister pack

21. Improve patient-pharmacist-physician relationship
Regular pharmacist follow-ups &maintain patient contact

22. Coping with illness
التعامل مع المرض

23. There are different factors affecting coping with illness as stress (إجهاد), motivation(حافز) and personality disorders.(اضطرابات الشخصية)
The pharmacist is in good situation to increase the coping of patients with illness

24. STRESS Around 85% of illnesses are psychosomatic (نفسي ).
Stress is a combination mental, physical and emotional symptom affecting most of the body system.

25. Causes of stress
Environmental factors: surrounding people, work family problems, partners, divorce, unbalanced life, unexpected events, changed values, frustration (إحباط).
Personal factors: super sensitivity, jealous, selfishness, personality disorders.
Chronic diseases: multiple diseases.
Multiple factors : combination of all of these

26. Signs and symptoms of stress
1. Physical:
Headache, fatigue, dyspepsia, nausea, vomiting, heartburn,cold skin, hairfall,sweating, decreased appetite, over breathing,palpitation,cramps,excessive yawning
2. Mental:
Confusion, decreased concentration, poor memory, poor self image, Improper perception, anxiety, Insomnia, polysomnia, increasing feeling of isolation, nightmares.

27. 3. Emotional: depression, irritability, nervousness, moody, lacks of interest. Habits: Inability to relax, drinking more tea,coffee, alcohol, smoking more cigarettes.

28. Treatment of stress Biofeedback Change of environmental factors.
Multivitamins, trace elements, minerals.
Exploring problems to others.
Medicinal herbs: valerian