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

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

3. 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.

4. Patient Adherence to Medications

5. 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”

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

7. Self Management Support o Demonstrating new skills o Praise & Feedback

8. Self-Management

9. Chronic Care Model

10. Global Medication Adherence is 50%

11. WHO’s Five Dimensions of Adherence

12. 1. Social & Economic

13. o Community Support

14. 1. Social & Economic o Economic

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

16. 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.

17. 1. Social & Economic Use Pictures When Teaching

18. 2. Health Care System o Provider-Patient Relationship

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

20. o Shared Decision Making 2. Health Care System

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

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

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

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

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

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

27. o Follow up Appointments 5. Patient Related

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

29. Conclusion

30. QUESTIONS AND DISCUSSION?

31. References o Agency for Healthcare Research and Quality. (2002). Preventing Disability in the Elderly with Chronic Disease. Retrieved May 15, 2010, from http://www.ahrq.gov/research/elderdis.htm. http://www.ahrq.gov/research/elderdis.htm o Chronic Care Model (2010). The Chronic Care Model. Retrieved June 15, 2010, from http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Mo del&s=2 http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Mo del&s=2 o Goldberg, E., Dekoven, M., Schabert, V., et al. (2009). Patient Medication Adherence: The Forgotten Aspect of Biologics. Biotechnology Healthcare, 39-44. 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

32. 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) 114-147. 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), 53-59. o Simpson, R. (2006). Challenges for Improving Medication Adherence. The Journal of the American Medical Association, 296(21), 2614-2616. o World Health Organization. Adherence to Therapies: Evidence for Action. Geneva: World Health Organization, 2003

33. Contact Information Susan Fleming, MN, RN, PhD student sefleming@wsu.edu Michele Wolfe, MN, RN bluchel1@msn.com