Studies show that approxi- mately 25% of all prescribed doses are omitted by patients.
This was in 1999 more recent studies say 50% are non adherent. like the study below:
Who. Defining adherence. Who. 2003;:1–28. www.who.int/chp/knowledge/publications/adherence_report/en/?
No single intervention is totally effective for all patients and it is not yet possible to predict which individual or subgroup actually needs a given intervention.
Patients also are reluctant to admit non-adherence unless clinicians make specific efforts to monitor the degree of adherence on a regular basis.
Studies have demonstrated that MEMS is more accurate than other available methods and is therefore considered the ‘‘gold standard’’ of adherence measurement. Despite these advantages, this tool has not yet been applied widely due to its cost and other practical issues that limit its use in large studies and routine clinical practice.
Although poor adherence is directly linked to patient behavior, there is no definitive data that has defined a ‘non-adherent’ personality or revealed a relationship between adherence and the ability to follow self-care or lifestyle recommendations.14 Likewise, medication adherence has not been shown to be correlated to demographic variables such as age, gender, or race, although there is a weak relationship with lower education and income levels. There are many variables that can be factored into adherence behavior outside of demographic variables that have greater utility as a predictor of medication adherence behavior. Table 1 categorizes the predictive strength of consumer-related variables (and their interaction within the health care system) as they are presented in the literature.
Moreover, the decision to be adherent is unique for each medication, and driven by three factors: (1) the perceived need for the medication (related to their understanding of the disease and therapy): (2) the perceived concerns about the medication (related to side-effects and safety); and (3) the perceived medication affordability.
National Consumers League’s Approach
The National Consumers League has launched a medication adherence awareness campaign entitled “Script Your Future”. The multiyear effort focuses primarily on patients affected by diabetes, respiratory disease, and cardiovascular disease. It is a powerful campaign that educates the consumer that poor medication adherence can lead to consequences that affect their ability to take care of themselves and their loved ones, places undue emotional and financial burden on family members, and jeopardizes the ability to experience future family events and milestones. The campaign also encourages patients and health care professionals to better communicate about ways to improve medication adherence.
Physicians, particularly primary care physicians (PCPs) and other specialists that write prescriptions for chronic diseases, can play a key role in addressing medication adherence given that they represent the initiation of the prescription process and have the opportunity to develop a trusting relationship with the patient.
This is a very important paper!
Although the term compliance has been in use for the longest period of time, nowadays it is considered that it is not entirely adequate and that changes in the relation between patients and healthcare professionals must be taken into consideration. Patients’ status is no longer submissive and passive and their role in accomplishing therapeutic objectives does not only imply compliance with medical instructions but active cooperation and agreement with a doctor and a pharmacist. Due to these reasons the term adherence has become more desirable in practice since the 90’s of the 20th century.
Differences between compliance and adherence are thus not only in the semantic sense but of essential nature. While in compliance the focus is on the healthcare provider who has a dominant status in relation to the patient, the concept of adherence is oriented to the patient and cooperation. In relation to this, the flow of information is one-way and the objective is to achieve obedience of the patient, while adherence implies a two-way information transfer and engagement of both subjects.[Top]
this is a well written literature review.
A key question across domains is, “how are patients/health agents/consumers persuaded to acquire certain drugs and take them as directed?”
The introduction of “concordance” to the literature on medication compliance and adherence—“adherence” is the most neutral, non-ideological, term for patient behavior, in use at least since the mid 1990s.
The question that concordance theorists have really asked is not, “how do we treat patients’ health beliefs more respectfully?” but rather, “how do we persuade patients to follow the advice of their doctors?”
We can frame a rhetorical question across domains: how are people persuaded to take drugs?
Several authors have written even-handedly about concordance and make clear that cooperation between physicians and patients is likely to lead to better, and more appropriate, use of medications. Elwyn, Edwards, and Britten write, “Concordance describes the process whereby the patient and doctor reach an agreement on how a drug will be used, if at all. In this process doctors identify and understand patients’ views and explain the importance of treatment, while patients gain an understanding of the consequences of keeping (or not keeping) to treatment.” Ferner writes, “Usually…the patient, who has most to gain by success and the most to lose from harm, should decide whether to have treatment, and the prescriber should provide information on the risks and benefits to help make the decision.”
It is easy to agree that cooperative, better-informed, and realistically-prepared patients are more likely to adhere to recommended treatments than those who are resistant, ill- informed, and unprepared.
So, “concordance,” with its egalitarian rhetoric, not only portrays physicians and patients as equals but also portrays all patients as equals—while, in truth and in practice, patients are not all equally well-equipped for consensual decision-making, and, certainly, not all physicians believe that they are. When one exits the concordance literature to enter other literature about patients, what becomes clear is that the respect for patients that is invoked as the key resource of concordance is not always available to be tapped.
The more consumers are aware of a drug, the more they will request it; arguably, if they request it, then, being in agreement with their physician on its prescription, they are more likely to adhere to treatment.
After the first audit we recommended that prescription scripts should be checked by the prescribing physician and re-checked by the nurse assistant in the clinic. Can be connected with this paper.
we strongly advocate more training of junior physicians to avoid these errors and to understand the potential hazards due to prescription errors. Same advice as this paper.
Computer-based prescribing systems may minimize the risk of errors due to illegible prescriptions. However there is a considerable financial investment and training involved which may be prohibitive for some institutions. From this external paper.
Knowledge of where and when errors are most likely to occur is generally the first step in prevention of prescription errors.[Top]
Reasons for interventions were grouped into 21 different categories. In some cases pharmacists cited multiple reasons (i.e., problems) for their intervention. Overall, 102 problematic e-prescription orders required intervention. Participating pharmacists documented a total of 113 reasons for intervention. The most common reason for pharmacists’ interventions on e-prescriptions was to supplement omit- ted information (32.7%), especially missing directions. Other common problems included insufficient (9.7%) or excessive (8.0%) dose.
They identify problems with overdose or wrong directions on how to take the medicine, drug-drug interaction etc. I suppose that these problems would interfere with patient compliance and adherence towards the medicine.
Prescribers may be more likely to make prescribing errors when using software or software options with which they are unfamiliar.
Pharmacists in this study recognized most problems independently of computer-assisted expert systems. However, pharmacists reported that computer systems were useful in identifying non-formulary medications, drug–drug interactions, and drug–allergy conflicts. These data once again emphasize that the currently available computer-assisted drug-use review decision support systems can be helpful but are not capable of supplanting the clinical judgment of the pharmacist. Can be connected with this paper.
Several recommendations can be made to improve the safety of e-prescribing in the community practice setting. First, physicians should perform their own e-prescription data entry or at least carefully review e-prescriptions that are entered by support staff before transmission to the pharmacy. Second, prescriber- side decision support software should be enabled and routinely used. Third, e-prescribing system safeguards and decision sup- port should be improved to more closely scrutinize new prescriptions to prevent commonly occurring errors. Fourth, when developing decision support systems for e-prescribing, special emphasis should be given to dosing error prevention.[Top]