Medication Adherence and Rates • Adherence is defined as “the extent to which a person’s behavior-taking medications, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider” (Sabaté, 2003) • There are 43.1 million elderly citizens in the United States (National Center for Health Statistics, 2014) • From 2007-2010, 50% of adults 60 and older took 1-4 medications in a month (National Center for Health Statistics, 2014) • 37% of Chinese geriatric patients do not take their medications as prescribed (Lam, Lum, & Leung, 2007) • 51% of geriatric patients need help remembering to take their medications (Sanders & Oss, 2013) Medication Influences Costs of Low Adherence • Best indicator of adherence is medication class (Fischer et al., 2010) Ex. Psychiatric medications are adhered less often (Tsai et al., 2012)-possibly due to side effects • Polypharmacy- (taking/prescribing multiple medications) contributes to a complicated patient treatment plan and lower adherence. • 42% of patients taking 3 ≥ medications had low adherence (Lam, Lum, & Leung, 2007) • Low adherence costs Americans $290 billion each year (New England Health Institute, 2009) • 125,000 deaths are due to low adherence (Vik, Maxwell, & Hogan 2003; Tsai et al., 2012) • 10% of hospitalizations, 23% of nursing home admissions are due to low adherence (Vik, Maxwell, & Hogan, 2003; Peterson, Takiya, & Finley; Tsai et al., 2012) • Side effects/withdrawal patients experience from skipping or forgetting a medication dose • Patients with low medication adherence may skip follow up physician visits Risk Factors for Low Medication Adherence • Depressed patients take their medications and refill prescriptions less regularly (Kilbourne et al., 2005) • Low self-efficacy of one’s ability to take his or her medications is correlated with low adherence in HIV patients (Colbert, Sereika, & Erlen, 2012) • Misinformed perception of medications/illness affect adherence rates (Mann, Ponieman, Leventhal, & Halm, 2009) Outcomes of Pharmacist Intervention to Improve Medication Adherence Variable Treatment as Usual n=192 67.9% (63.8-72.1) 66.7% (62.3-70.9) 47% (43.4-50.9) Pharmacist Intervention n=122 78.8% (74.9-82.7) 70.6% (64.9-76.2) 53% (49.1-57.1) Medication Adherence During Intervention (CI) Medication Adherence 3 Months Post (CI) Medications Taken On Schedule During Intervention (CI) Medications Taken On 48.6% 48.9% Schedule After Intervention (44.7-52.6) (43.7-54.1) (CI) Hospital Admissions (SD) 0.97 (1.78) 0.78 (1.66) Emergency Department 2.68 (4.87) 2.16 (3.31) Visits (SD) Trends: overall outpatient costs in intervention group were $886 (CI, -$2289-660) lower than the treatment as usual group. Each subject in the intervention group saved about $2960 (CI, -7603-1338) in healthcare costs. Figure 1. (Murray et al., 2007) Healthcare Providers can Improve Medication Adherence • Recognize the signs of low adherence • Be aware of the number of medications a patient takes • Limit the number of medications prescribed (Lam, Lum, & Leung, 2007) • Educate patients on their illness and medications • Use screening measures (BMQ, MMAS, REALM-SF) • Improve and sustain patient-provider communication (Murray et al., 2007; Cohen et al., 2012) • Use integrated healthcare teams involving pharmacists, social workers, nursing staff and physicians (Lee et al., 2013) • Improve medication bottle labeling (Bailey et al., 2014) • Ask patients about social support (family, friends, healthcare providers)-this can increase adherence by 25% (Lam, Lum, & Leung, 2007) • Pharmacists who were trained to work with low literacy heart failure patients and recognize signs of low adherence improved patient adherence rates, decreased health costs, and decreased hospital admissions (Murray et al., 2007) Future Research Implications • Research on geriatric medication adherence in the U.S. is needed • Research focusing on decreasing polypharmacy is needed • Further developing research based interventions is essential to improving medication adherence • Implementing self report recommendations suggested by patients is important to decreasing medication adherence References Bailey, S. 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