Pharmaceutical Seminar-5

Medication Adherence

Shristi Pantha
Pokhara University,
Faculty of Health and Allied Sciences,
School of Health and Allied Sciences,
Pharmaceutical Sciences Program
 Overview
• Introduction
• Factors affecting medication adherence
• Methods of measuring medication adherence
• Methods to improve medication adherence
• Conclusion
• References

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 Introduction
Medication Adherence
Defined by WHO (2003) as “the extent to which a person’s behavior
in taking medication corresponds with agreed recommendations
from a health care provider.”
Though the terms adherence and compliance are synonymously
used adherence differs from compliance. Compliance implies
patient obedience to the physician’s authority whereas adherence
signifies that the patient and physician collaborate to improve the
patient’s health by integrating the physician’s medical opinion and
the patient’s lifestyle, values and preferences for care.
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Benefits of Medication Adherence;
• enhances patient safety,
• decrease health care costs,
• improves long-term therapies and outcomes, and
• good investment for tackling chronic conditions.
Worldwide, non-adherence is a major obstacle to the effective
delivery of healthcare.

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 Factors affecting medication adherence
Adherence is a multidimensional phenomenon determined by
the interplay of five sets of factors, termed “dimensions” by the
WHO :

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Social/econom Illiteracy, High medication cost, Cultural and lay beliefs, Family
ic dysfunction,
Health Poor patients-provider relationship, Poor health services, Short
system/ HCT consultations, Lack of incentives and feedback on performance

Condition Level of symptom severity, Availability of effective treatments, Co-

morbidities
Therapy Immediacy of beneficial effects, Side effects, Duration of treatment,
Previous Treatment failures, Complexity of regimen
Patient Inadequate knowledge about treatment, Stigma surrounding disease,
Forgetfulness, Hopelessness, Low attendance at follow-up

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 Method of measuring adherence
A) Direct Methods
 Include directly observed therapy, measurement of level of
medicine or metabolite in blood and detection or measurement
of a biological marker added to the drug formulation, in the
blood.
 Direct approaches are one of the most accurate methods of
measuring adherence but are expensive. Moreover, variations in
metabolism and “white coat adherence” can give false
impression of adherence.
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B) Indirect methods
 Self-reports and interviews with patients are the most common
and simplest methods of attempting to determine adherence.
However, questioning the patient can be susceptible to
misrepresentation and tends to result in the health care
provider’s overestimating the patient’s adherence.
• In spite of the limitations of interviews, asking carefully
constructed question (eg, “Most people have trouble
remembering to take their medicine. Do you have trouble
remembering to take yours?”) in non threatening manner will
help to identify some non adherent patient.
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 Morisky Medication Adherence scale
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 Pill counts i.e. Counting the number of pills that remain in the
patient’s medication container on return visit or during an
unscheduled home visit is a common method to measure
adherence. However, pill dumping (i.e. attempts by patients to
misrepresent their compliance by discarding medication )is
common.

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 Rates of refilling prescriptions are an accurate measure of overall
adherence in a closed pharmacy system. A medical system that
uses electronic medical records and a closed pharmacy system
can provide clinician with readily available objective information
on rates of refilling prescription that can be used to assess
whether a patient is adhering to the regimen and to corroborate
the patients responses on direct questionnaries.

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 Medication event monitoring
system(MEMS):
Electronic monitors are capable of
recording the date and time of
opening of medication bottle
through microprocessor
technology embedded in the cap.
The disadvantage with this
method is that the patients may
open the container and not take
the medication, take the wrong
amount of medication.
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 Methods of improving medication
adherence
The effectiveness of a treatment depends on both the efficacy of a medication
and patient adherence to the therapeutic regimen. Patients, health care
providers, and health care systems, all have a role to improve medication
adherence.
A systemic approach that could be instituted in improving medication
adherence is as follows:
 Introduce a collaborative approach with the patient at the level of prescribing
 Explain the treatment options
 Simplify medication taking (Simplify regimen)
 Fit medication into patients schedule

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 Explain key information when
prescribing/dispensing a medicine(which,
why when, how and how long), inform
about common side effects.
 Reinforce all discussions often, especially for
low –literacy patients
 Use medication adherence improving aids :
medication calendars, drug cards, charts,
specific packaging’s such as pill boxes,
reminder calls texts email apps

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 Provide behavioral support: incorporate regimen into patients daily
regimen(in case of complex dose regimen , those having
unintentional difficulties in adherence e.g. elderly)
 Identify difficulties and barriers related to adherence
 Address the problems, fears ,concerns
 Ensure that patients understand the positive benefits of taking their
medications
 Develop patient-centered communication style
 Schedule appropriate follow up
 Assess adherence during consequent follow ups (measure
adherence, check the effectiveness of adherence aids)
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 Conclusion
Patient medication non adherence is a major medical problem globally.
There are many inter related reasons for the same. Though patient
education is the key to improving adherence, use of adherence aids,
proper motivation and support is also shown to increase medication
adherence. Health care professionals should identify practically
possible strategies to improve medication adherence within the limits
of their practice eventually enhancing therapeutic outcome. It should
be a multidisciplinary approach that needs to be carried out with the
support of all those who are involved in medication use.

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 References
• Parthasarathi, G., Hansen, K.N., and Nahata, M.C. (2005). A Textbook of
Clinical Pharmacy Practice: Essential concepts and skills. 2nd edn.
Hyderabad: Orient Longman Private Limited, pp. 54-65.
• Gennaro, R.A. (2006). Remington: The Science and Practice of Pharmacy.
Volume II 21st ed. Philadelphia: Lippincott Williams & Wilkins, pp.1783-
1791.
• Jimmy, B. and Jose, J. (2011). Patient Medication Adherence: Measures in
Daily Practice. OMJ, 26(3), 155-159.
• URL:
https://www.who.int/chp/knowledge/publications/adherence_full_report
.pdf
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 Thank You!

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