Patient Focused Intervention To Enhance Medication Adherence

The pharmacist interventions can be patient focused (health), and or drug focused (drug therapy). Patient-focused interventions are those that recognise the role of patients as active participants in the process of securing appropriate, effective, safe and responsive healthcare.

Medication adherence

As individuals or family members, patients can play a distinct role in their own care. This can be done by diagnosing and treating minor, self-limiting conditions; by preventing occurrence or recurrence of disease or harm; by selecting the most appropriate form of treatment in partnership with health professionals for more serious illness; by actively managing long term conditions; and by medication adherence.

Fostering high standards of health literacy and a sense of ownership of their health may be the best way to ensure that people adopt healthier lifestyles, helping to meet health and behavioural targets as well as moderating demand for healthcare resources.

Medication Non-adherence can take a variety of forms, including not having a prescription filled, taking an incorrect dose, taking medication at the wrong time, forgetting to take doses, or stopping therapy too soon.

Goals Of Patient-Focus Intervention

Patient-focused interventions are generally aimed at one or more of the following seven quality improvement goals:

1. Improving health literacy

2. Improving clinical decision-making

3. Improving self-care

4. Improving patient safety

5. Improving access

6. Improving the care experience

7. Improving service development

Factors That Influence Medication Adherence

Factors That Improve Adherence

Disease-related factors: when a patient perceives that the disease is severe or will get worse, they tend to adhere more.

Treatment related factors: patients with flexible dosage will be more likely to adhere to the treatment plan. Also, treatment with a glaring effect encourages adherence as well as a clear plan.

Patient related factors: this is where pharmaceutical care skills come in. A patient with good rapport with the pharmacist, confident with him and was actively involved and we'll be informed about the disease, treatment plan and goal will be more cooperative. Lest I forget the contribution of family members cannot be over emphasized.

Factors That Reduce Adherence

Disease related factors: when a patient feels like the condition is not severe (lack of symptoms), they will likely not be interested in the treatment. Now if the condition is chronic, it will be difficult to adhere to medication.

Treatment related factors: very difficult to encourage a chain smoker to quit smoking for the period of treatment. And it becomes worse when the treatment regimen is complex. An example is drugs like loperamide and ergotamine dosing that is not based on just weight or age and number of hours. Also, development of unpleasant side effects with or without significant improvement in condition after taking medication will lead to non adherence.

Socioeconomic-related factors: Socioeconomic-related factors included location of residence and current smoking status. In addition, high treatment costs affected medication adherence.

Patient-related factors: There were 6 main factors relating to patients were demographics, physical and mental function, disease and treatment, family history, and menopausal factors. Having lower education levels was linked to poorer medication adherence. Poorer medication adherence was also linked to higher age of menopause.

1. Sensory or cognitive impairments

2. Physical disability or lack of mobility

3. Lack of social support

4. Educational deficiencies (literacy problem) or poor English fluency

5. Failure to recognize the need for medication

6. Health is a low priority

7. Conflicting health beliefs

8. Economic problems

9. Negative expectations or attitudes toward treatment

Method Of Assessing Adherence

For pharmacist to be able to ascertain a patient is adhering to medication, they use two types of methods. They are direct and indirect method

Direct Method

In this method, blood or urine samples are analysed for metabolites or marker compounds. However, because these metabolites and marker compounds behave differently from person to person, this method is not a full proof method.

Indirect Method

One of the easiest methods is pill count. What if the patient throws away some pills to make the pill number balance the dose? That leaves pharmacists with other methods which are patient interview, refill records and symptoms assay. Patient interview is the cheapest yet more tricky. Patient may not understand the question hence gives a false report. Also, patients may lie their way through. Pharmacists are not trained to detect lies.

Probes Pharmacists Can Use To Assess Adherence

Assessing the patient's medication knowledge or medication-taking behaviour;

1. What is the reason you are taking this drug?

2. How do you take this medication?

3. Are you taking the medication with food or fluid?

4. Where did you receive information about this medication?

5. Are you taking non-prescription drugs while on this medication?

6. Do you use any memory aids to help you remember to take your medication?

7. Do you depend on anyone to help you remember to take your medication or to assist you in taking it?

Assessing attitudes, values, and beliefs regarding medication-taking behaviours;

1. What results do you expect to receive from this medication?

2. What are the chief problems that you feel your illness has caused you?

3. Do you have any concerns about your illness and its treatment?

4. Are you satisfied with your current treatment plan?

5. How well do you usually follow a treatment plan?

6. What is the main concern you have about your medication?

7. Do you feel comfortable asking your physician or pharmacist questions about your medications?

Assessing whether the patient has the proper skills and is motivated or willing to follow through on the therapy plan;

1. Have you encountered any problems with your medication-or pill-taking procedure?

2. Are you confident that you can follow your treatment plan?

3. What might prevent you from following the recommended treatment plan?

4. How likely is it that you will ask your physician or pharmacist about your medications?

5. Can you explain how you remind yourself to take your medication on schedule?

6. Do you normally write down questions to ask your physician or pharmacist before an appointment?

Designing Patient-Focused Interventions for Non-adherence

It is important to note that one plan cannot work for all patients. But they may be similar. Also, a plan that works from the beginning may regularly need fine tuning as the time passes because the patient may get used and tired of it.

There is not much to talk about. The patient should be involved in the decision making. The patient should be told what the disease is all about, what science already knows, what caused it, the risk, what it will lead to if not treated, the drugs, side effects, etc. Armed with this information, the patient will be well informed.

In all, avoid fear tactics which may only work for children. It can backfire. Then help the patient develop a d evaluate short and long term therapy plan. Follow-up is a must as it helps to determine if the intervention is working or not. Some recommend reward systems such as refill coupons. Just like most things that have advantages come with some disadvantages, look at it when the coupon is withdrawn and the consequences.

Medication Education/Counselling

For a patient to use a medication appropriately, the patient should know when and how to take the drug. The information include the dosage, frequency, duration, repute as well as others. There is a difference between information and education. A pharmacist can pass information down to a patient. The manner and way it was shared can affect the way it was understood. So pharmacist should learn how to educate their patients through passing on information. Learning how to pass the information using the right words without medical jargon showing empathy will go a long way. Patients should repeat the instructions for administering their medications to show that they understand and they also should be encouraged to ask questions.

Medication Education

1. The indication, name, form, dose, strength, frequency, route of administration and duration of any drug

2. Side and adverse effects

3. Precautions and interactions

4. Allergies

5. Storage conditions

6. Expected outcome and when to expect it

7. Action to take after miss dose, underdose or overdose

8. Lifestyle modifications

9. Educate family on roles to play

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