Describe the importance of good adherence and the consequences when
adherence is poor.
Describe effective strategies to promote adherence and discuss how to help
patients cope with non-toxic side effects of ARVs.
Demonstrate ways to counsel patients about adherence.
Develop a tool or questionnaire to measure adherence in your local context.
FACTORS INFLUENCING NON ADHERENCE:
1. The high cost of medicines:
According to research, as medical costs go up, adherence goes
down. It is understandable that patients will not take medicines
if they cannot afford them in the first place. Healthcare
providers must put in the effort to determine if a patient can
afford the medicine being prescribed and help secure financial
assistance for those who can’t.
II. Lack of understanding about medicine regimen:
When patients do not understand how or when to take medicine, they may skip some
doses or totally avoid the medication. Such patients will benefit from meetings with
their pharmacists to learn properly about their medication regimens. The pharmacists
can help them create pill calendars and teach them how to use apps that remind
patients about the medications.
III. Side effect scares:
Most medicines have some side effects or the other. Some of these negative effects
wear off when the patient adapts to the new treatment while certain side effects
may be long-lasting. In such cases, the patient may require additional treatment to
address these side effects. Non-adherence increases when patients don’t know who to
turn to or what to do when they experience such unpleasant or scary side effects.
IV. Difficulty in refilling medication:
Those suffering from chronic medical conditions will need to refill their medications on a
regular basis. Non-adherence to medications occur when patients face difficulty in getting
their prescriptions renewed. It can get quite frustrating when they have to make multiple calls
to their physician’s office, wait on hold and navigate through complex phone trees only to be
told to call again later. Centralized refill hotlines manned by pharmacists can solve such issues
and ensure prescriptions are filled up without such hassles.
V. Inconveniences in accessing medication:
These factors determine whether or not the patient's family members, healthcare providers,
the local community and society are supportive enough to assist in medication adherence.
These may be negative or positive based on there behavior and attitude.
STRATEGIES TO OVERCOME NON-ADHERENCE
The effectiveness of a therapeutic regimen depends upon both the patient adherence and
efficacy of the medicine. Thus, healthcare providers, as well as the system, have a great role
in improving medication adherence. Improving in a single factor cannot provide a 100%
success rate in compliance. There is a need to use a combination of various techniques to
improve patient’s adherence to the prescribed therapy. Following are some approaches that
can be implemented to improve compliance.
1. Level of Prescribing:
For improving compliance there is a need to introduce two-way approaches during
prescribing the medicine. Before prescribing the medicine, a doctor should discuss or
ask the patient for a convenient preparation/dosage form and according to the
possibility, a doctor should prescribe or change the treatment plan.
At the time of prescribing or dispensing of drugs, the health practitioners should
explain the key information such as; what, why, when, how, and how long to take
The common side effects may result after the use of the regimen and if it is
necessary to know to a patient then should be explained by health practitioners.
To improve patient compliance then provide a medication calendar, medication chart,
drug information sheet, special container indicating a time of dose, etc.
To improve patient compliance, it is necessary to provide behavioral support.
Sometimes there is also a need to collaborate with patients to incorporate the
medication regimen in their daily schedule particularly when there is a complex
therapeutic regimen and in elderly patients.
2. Communicating with the Patient:
3. By Simplifying Therapeutic Regimens:
Many times, patients avoid or discontinue using drugs due to complex regimens. Doctors
of drug administration. Doctors can prescribe a combination of drugs in a single tablet.
Frequent administration of a drug can be avoided by prescribing sustain dosage forms or
long-acting drugs. For example: sustain release glibenclamide and metformin in diabetes and
morphine for chronic pain. The advantage of such kind of sustain released preparation is
minimizing adverse effects.
In certain conditions (diabetes, tuberculosis, HIV), compliance can be improved by educating
the patients about their disease condition and the necessity of medicines for their
treatment. Patient education is always to be encouraged if it improves compliance.
A patient can also be helped by providing the leaflets for drug information and
instruction to take the medicine particularly for ear drops, pessaries, and suppository.
At each visit patients should bring their tablets with them this allows the doctors to
know exactly what drugs the patient is taking. For monitoring the compliance as well as
demonstrating the correct method of drug administration patient was asked to have the
medicine in front of the Doctor.
4. By Educating the Patient: