Like every set goal, it takes discipline and commitment to adhere to the dosage regimen prescribed by the doctor or pharmacist. Medication adherence is described as the extent to which medication intake behavior corresponds with the advice of the health care provider (WHO, 2003). It usually refers to whether patients take their medications as prescribed (e.g. one tablet 12 hourly), as well as whether they continue to take a prescribed medication for the prescribed duration. Medication non-adherence on the other hand, can be described as the degree to which the patient does not carry out the clinical recommendations of a treating physician. It is a growing concern to clinicians, healthcare systems, and other stakeholders (e.g. payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. Medication adherence behavior has thus been divided into two main concepts, namely, adherence and persistence. Although conceptually similar, adherence refers to the intensity of drug use during the duration of therapy, whereas persistence refers to the overall duration of drug therapy.
REASONS FOR MEDICATION NONADHERENCE
1. Health system– Poor quality of provider-patient relationship; poor communication; lack of access to healthcare; lack of continuity of care
2. Condition– Asymptomatic chronic disease (lack of physical cues); mental health disorders (eg, depression)
3. Patient– Physical impairments (eg, vision problems or impaired dexterity); cognitive impairment; psychological/behavioral; younger age; nonwhite race
4. Therapy– Complexity of regimen; side effects 5. Socioeconomic– Low literacy; higher medication costs; poor social support
INTERVENTIONS
The interventions are aimed at tackling either one or more of the reasons why patients are non-adherent to medications through the following:
1. Ensuring good provider- patient relationship and proper communication: Here, the provider explains in detail why he/ she is prescribing the drug, what the drug will likely achieve and the need for the patient to adhere to the drug regimen for the given period of time. The side effects of the drug should also be properly explained to the patient if any. The provider should also ensure that the drug is cost effective for the patient. E.g. a patient on Nevirapine, an anti-retroviral drug, needs to be properly counseled on the need for adherence in order to prevent treatment failure, increased viral load and eventual unwanted sequel for the patient.
2. Access to health care: Government and pharmaceutical industries should make sure that these medications are not scarce in certain areas. Inaccessibility to drugs almost always discourage patient from adhering to medications even if they would normally want to.
3. Directly Observed Therapy (DOT): This was the intervention for non-adherence to anti-TB medications. The patient goes to a health center close to him/her where the drugs are administered by the nurse and she ensures that the drugs are taken. This is important because tuberculosis is a highly infectious disease and must be curbed. The drawback is that the patient may find it rather inconvenient to always go to the clinic to take his/her drug hence, resulting in a default.
4. Adjustment of the medication: Using combination pills to reduce the number of pills daily, for example, the Artemisinin-based Combination Therapy (ACT) for malaria has been made as double strength (six tablets) instead of the usual twenty-four tablets. This is more patient-friendly as the patient doesn’t need to take numerous drugs. The duration of treatment for TB has also been reduced to 6 months. This is better than 8 months or 12 months which mostly puts the patient off.
5. Patients who are physically impaired or those that are of young age: A home care provider is compulsory and the details of the medication should be clearly explained to them. It is also necessary to involve the relatives if the patients in the pharmaceutical care of the patient. Close monitoring by the healthcare provider is also essential.
6. Cognitive behavioral therapies (such as motivational interview by trained counselors): Medication-taking reminders (such as refill reminder calls or use of electronic drug monitors for real-time monitoring and reminding); and incentives to promote adherence (such as reducing co-payments and paying patients and clinicians for achieving disease management goals) are some alternative interventions to encourage medications adherence.
Medication adherence is especially important in the cases of chronic diseases such as diabetes mellitus and hypertension, where multiple therapeutic regimens are employed. Reasons for medication non-adherence are multifactorial and may vary with different settings and populations. Hence, it is important for the healthcare provider to monitor the patient’s compliance with the dosage regimen while identify probable causes of no adherence, in the case of one. Addressing such factors has been shown to improve adherence and ultimately, patients’ therapy.
CONTRIBUTORS: Pharm. Gloria Nwankwo, Pharm. Chioma Odogwu, Pharm. Rejoice Thomas Kaigama, Pharm. Mmesoma Mgboko, Pharm. Taiwo Olawehinmi, Pharm. Temitayo Soyinka, Pharm. Obianuju Nnedigwe, Pharm. Samuel Adedoyin, Pharm. Rufina Ezeanowi, Pharm. Onyedikachi Obike, Pharm. Chisom Anaedu, Pharm. Temidayo Aderibigbe.