This document discusses medication adherence and strategies to improve it. Key points: - Medication non-adherence leads to 125,000 deaths annually and costs $300 billion per year. - Goals of adherence include establishing trusting patient relationships, engaging patients in their therapy, and providing follow-up care. - Causes of non-adherence include not filling prescriptions, not refilling on time, missing doses, or stopping medication early. - Pharmacists should communicate simply with patients, reinforce benefits, educate on medications, confirm understanding, and follow-up after therapy starts to achieve therapeutic success.

1. ADHERENCE TO
MEDICATION
Johanna Visa, pharmD
April 2016

2. Why do we care?
• Medication non-adherence:
• Nearly 125,000 deaths per year in the US
• Linked to ~ 33% to 69% of hospital admissions and 23% of nursing
home admissions
• Important financial implications:
• 3 out of 4 people in the U.S. do not take their medication as
prescribed
• ~ $300B of avoidable health-care costs annually are due to non-
adherence; 3 to 10% of total health-care costs
• Challenging in everyday practice in both community
pharmacy and hospital
> Requires patient agreement to therapy: “Drugs do not
work in people who do not take them”

3. What are the goals of the adherence to
medication?
• Establish a positive, supportive and
trusting relationship with the patient
• Talking with the patient one-on-one
• Asking the patient open-ended questions
• Engaging the patient in his therapy
• Quizzing the patient on what the drug is for
leads to:
!Better patient outcomes
!Therapeutic success
• Provide an appropriate follow up care
> Proper medication adherence starts with a conversation

4. Causes to non-adherence
• Failing to initially fill a Rx
• Failing to refill a Rx as directed
• Omitting a dose or doses
• Prematurely discontinuing medication (can be an
economic cause)
• Taking doses at the wrong time
• Taking dose with prohibited foods or liquids or other
medications

5. How to achieve the therapeutic success?
• Simple communication with the patient
• Reinforce the benefits of the therapy
• Educate the patient about his
medication
• Confirm understanding of patient’s
therapy
• Follow up with the patient after 72hrs
the therapy has been started
> Proper medication adherence starts with a conversation

6. Case Study: example of Furosemide
Patient:
• 50 year old male with chronic disease and heart failure
• Rx of fursosemide
• Did not pick up his diuretic last month
• Frustrated with all the medications, does not understand
how they work, complains he has to use the bathroom
often
Pharmacist action:
• We engage, we listen, we connect the dots
• We have him motivated to change his current behavior to
get rid of extra fuild overload from heart failure

7. What do we need to change to drive
better outcomes?
• Adopt a patient-centered strategy
• Gain his/her confidence
• Adapt a trusting relationship
• Ask open-ended questions
• Work in tandem with the patient
• Let the patient understand the
pharmacist is really engaged:
• Let him know about following up with a caring call after 3 days he
started his therapy then 30 days later, repeat the caring call and
remind him to refill his Rx on time

8. What do we need to change to drive
better outcomes?
• Leading patient to interviewing him
by listening to her and express
empathy
• Understand patient stay at the hospital
• Explain his current medication and
collaborate with him
• Determining the patient’s point of view
helps draw out the patient’s own
motivation toward a behavior change
leading to adherence medication is the
key to therapeutic success
> Establish a positive, supportive and trusting relationship
with the patient