Medication adherence is defined as a patient conforming to a healthcare provider's recommendations regarding timing, dosage, and frequency of medication. It involves filling prescriptions and refilling on time. Non-adherence can be caused by patient factors like forgetfulness or cost barriers, physician factors like complex regimens, and health system factors like fragmented care. Pharmacists can improve adherence through education on medication purpose, usage, and side effects. Adherence is especially important for chronic conditions and can be monitored through patient assessments.

1. Medication
Adherence
Prepared By:-Ms.Mali Sunayana
Asst.Professor
Subject-Pharmacy Practice
Sahyadri College of Pharmacy, Methwade
UNIT-II Topic-VIII
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2. ∆ Introduction:-
Hippocrates,Decorum: Medication adherence is more than
just taking your medications.There are three specific terms
that can be associated with medication adherence. Each of
these terms plays a critical role in making sure that patients
understand how to use their medications, along with making
sure they get the best outcomes.
1]Adherence
2] Compliance
3] Persistence
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3. 1) Adherence : Defined as the patient's conformance with the
provider‘s recommendation with respect to timing, dosage and
frequency of medication. In other words, the act of actually filling
the prescription and getting it refilled when necessary.
2) Compliance: How well the patient follows the instructions of
when and how to take the medication.
3) Persistence: Defined as; how well the patient continues their
medication regimen.
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4. The WHO defines adherence to Iong-term therapy as: "the extent
to which a person‘s behavior taking medication,following a diet,
and/or executing lifestyle changes corresponds with agreed
recommendations from a healthcare provider.”
Treatment ->Adherence -> Outcomes
This definition of adherence assumes that the patient has been
an active member of the health care team and is in full
agreement with the recommendations presented to them,
which differentiates it from compliance. where the patient is
simply doing as is told by their provider
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5. MEDICATION ADHERENCE
¶ DEFINITION:-
It is defined as the exact or extent to which a
patient medication taking behaviour concedes
with the intention of the health advice he/she has
been given.
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6. Adherence consists of three essential factors:
√ Patient (individual health literacy and involvement in the
treatment decision process).
√ Provider (the decided prescription drug regimens and
corresponding communication barriers)
√ Health care system (access to care, time aliotted for visits ahd
technology)
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7. ∆ IMPORTANCE OF MEDICATION ADHERENCE:-
There are many situations in clinical practice where adherence is
extremely Important for better therapeutic outcomes. These include:
1) Chronic diseases: such as diabetes and hypertension.
2) Replacement therapy: e.g Thyroxin and insulin.
3) Maintenance of pharmacological effect: antihypertensive and oral
hypoglycemic agents.
4) Maintenance of serum drug concentration to control a particular
disorder. e.g. anticonvulsants.
5) Some diseases of public health importance where non-adherence are a
major obstacle to achieving control: tuberculosis, HIV, and related
opportunistic infections.
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8. ∆ CAUSES OF MEDICATION NON-ADHERENCE:-
Poor adherence to medical treatment severely compromises
patient outcomes and increases patient mortality. According to
the WHO, improving adherence to medical therapy for
conditions of hypertension, hyperlipidemia and diabetes would
yield very substantial health and economic benefits. To
improve medication adherence, the Multi-factorial causes of
decreased adherence must be understood.
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9. The WHO classifies these factors into five categories:
1] Socioeconomic factors
2] Factors associated with the health care team and system
in place
3] Disease-related factors
4] Therapy related factors
5] Patient-reiated factors.
In broader terms, these factors fall into the categories of
patient-related factors, physician-related factors and
health system/team building related factors.
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10. 1] Patient Related Factors:-
√ The most common reasons given by patients for not
taking their medications are forgetfulness (30%), other
priorities (16%), deciding to omit a dose (11%), Iack of
information (9%), and emotional reasons (7%); 27% of
patients give no reason.
√ Several patient-related factors including; lack of
understanding of their disease, lack of involvement in the
treatment decision-making process and suboptimal medical
literacy, contribute to medication non-adherence
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11. √ Factors that are associated negatively with adherence
include; increased complexity or duration of a medication
regimen, side effects, very old age, extreme poverty, social
isolation and psychiatric diagnoses, especially paranoia; a
study on adherence in HIV-positive individuals, which
included these patient-level factors, found that older HIV-
positive patients with neurocognitive impairments or drug
problems were at an increased risk of suboptimal medication
adherence when compared to their younger counterparts.
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12. Table No.1:Patients Understanding of Their Medication and
Adherence
Medication Knowledge Patients Answering
Correctly (%)
Dose 65.6
Frequency 49.2
Indiacation 19.7
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13. 2] Physician Related Factors:-
√ Not only do physicians often fail to recognize
medication non-adherence in their patients, they may
also contribute to it by prescribing complex drug
regimens, failing to explain the benefits and adverse
effects of a medication effectively and inadequately
considering the financial burden to the patient.
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14. √ Communication among physicians is often insufficient
and may contribute to medication non-adherence.
Direct communication between hospitalists and
primary care physicians occurs in less than 20% of
hospitalizations and discharge summaries are available at
less than 34% of first post discharge visits.
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16. 3] Health System / Team Building-Related Factors:-
√ Fragmented health care systems create barriers to
medication adherence by limiting the health care
coordination and the patient’s access to care.
√ Prohibitive drug costs or co-payments also contribute
to poor medication adherence.
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17. • Pharmacists are in unique position to improve
medication adherence because they can actually
show the medication to the patient and relate any
information to the medication itself.
• Pharmacists often provide verbal education and
written individualized information for the patient
although the benefits of these strategies alone are
unclear.
∆ Pharmacist Role In The Medication Adherence:-
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18. • A few studies provide evidence of level or
improved patient medication adherence as a result
of patient education given by pharmacy.
• Talking with patients about refilling about drugs in
pharmacy.
• Working closely with patients and their physicians
when patients require medication therapy changes.
• Giving the information to patients that each drug
and individual manner to help achieve their goals.
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19. The information that patients need to know which
pharmacists can impart includes:-
• Name and purpose of the drug.
• When and how to take the medication.
• Possible side effects.
• Precautions.
• Interaction with food or other drugs.
• Duration of therapy.
• Action to take if a dose is missed.
• How to tell if the medication is working or not working.
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20. ∆ Education and Medical Intervention in Medication Adherence:-
√ Ensure that patients know their medications by name, dosage and
reason for prescription; reinforce these points during every clinic visit.
√ Inform patients about the adverse effects of drugs. Provide written
instructions for each change in medication dose or frequency.
√ Reduce the number and frequency of medications. Where possible,
medications should be given either once or, at most, twice daily.
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21. √ Ensure the patients understand that they need to continue taking
immunosuppressive agents even if the transplanted organ is functioning
well.
√ Teach patients that chronic rejection is insidious in onset, hard to
diagnose in its early stages and often not reversible once established.
√ Attempt to treat adverse effects by means other than dose reduction.
√ Inquire about problems during every clinic visit, and address specific
patient concerns.
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22. ∆ Behavioral and Psychosocial Approaches for
Medication Adherence:-
√ Provide positive support to encourage adherent
behaviors during preparation for transplant.
√ Encourage patient to demonstrate a track record of
medication adherence and knowledge.
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23. √ Encourage individual team members to develop
Sympathy and Empathy with patient.
√ Identify and involve a backup support system (family
or friends).
√ Treat depression, anxiety or other psychological
issues.
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24. ∆ Eight Steps to Improve Medication Adherence:-
1.Consider medication non-adherence first as the
reason a patient's condition is not under control.
2. Develop a process for routinely asking about
medication adherence.
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25. 3. Create a blame free environment to discuss
medications with the patient.
4. Identify why the patient is not taking their
medicine.
5. Respond positively and thank the patient for
sharing their behavior.
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26. 6. Tailor the adherence solution to the individual
patient.
7. Involve the patient in developing their
treatment plan.
8. Set patients up for success.
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27. ∆ Monitoring of patient medication Adherence:-
√ Full adherence to medication is required as the
drug can be effective only when it is taken.
√ None the less, maintaining strict medication
adherence is required that deems maintaining
administration timing, dosage quantity and
frequency
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28. √ In general, two key factors should be considered when
discussing medication adherence, the first factor is
monitoring, which is alternatively referred to as
assessment, quantification, measurement or evaluation.
√ Direct measures are accurate, but they may require
invasiveness, and they are usually expensive. In
comparison, indirect methods are less expensive and
provide good estimation of the medication adherence.
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29. REFERENCES:-
1. A Text book of Pharmacy Practice by the author Sourabh Kosey
Nirali Prakashan. Page No.8.1-8.10
2. A Text book of Pharmacy Practice by the author Dr. Sachin V.
Tembhurne, Dr. Ashwini R. Madgulkar, Dr. Virendra S. Ligade
Nirali Prakashan. Page No. 8.1-8.8
3. www.Google.com
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