Helping Patients Follow Prescribed Treatment

Haynes, R. Brian; McDonald, Helen; Garg, Amit

doi:10.1001/jama.288.22.2880

Cited by 765 publications

(538 citation statements)

References 15 publications

(13 reference statements)

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“…A key validated question is, BHave you missed any pills in the past week?^, and any indication of having missed one or more pills signals suboptimal adherence requiring further exploration. 29 Compared with pill counts, asking non-responders about their medication adherence using this single question will detect 55 % of those with less than 100 % adherence. 30 Another common assessment question which incorporates motivational interviewing and is generally more patient-centered is, BA lot of people find it difficult to take their pills 100 % of the time.…”

Section: Evaluating Appropriate Medication Usementioning

confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decisionmaking for clinicians interested in providing patientcentered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of nonadherence to medications for chronic conditions. A dherence to medications is often suboptimal-up to 50 % of patients do not take their prescribed medication as recommended. 1-4 Medication non-adherence is associated with adverse health outcomes as well as negative social and economic consequences. [5][6][7] The problem of medication nonadherence is often multifaceted and multifactorial; in general, most conceptual models of medication non-adherence take an ecological perspective, and include patient factors (e.g., literacy, cognitive function), provider factors (e.g., complex regimens), social/community factors (e.g., access to providers and pharmacy), health care factors (e.g., interaction with healthcare system, trust, prior authorization, fragmentation), and policy implications (e.g., coverage of medication). 8-10 Thus, to be effective, interventions designed to improve appropriate medication use must adopt a comprehensive approach, often combining numerous proven strategies. Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.Evidence increasingly demonstrates that adopting a personcentered approach for medication use that incorporates patient beliefs, preferences, goals, and barriers to medication-taking (e.g., cost, technological ability, concerns about medication prescribing and use) leads to better clinical outcomes. 17,18 Clinicians are in a key position to elicit this information from patients and to incorporate it into medication-related decisions, thereby improving medication adherence rates. Person-centered care focuses on providing patients with greater choice, recognizing their roles as consumers of health care who know best their own beliefs and preferences. This care is meant to encourage value concordance-in this case, the match between the treatment that is selected and the treatment that i...

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Section: Evaluating Appropriate Medication Usementioning

confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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“…Hence, the patient's medication adherence has a crucial role in the treatment's success rate. Furthermore, available evidence indicates that a patient's persistence in chronic conditions considerably reduces after 6 months of treatment [3,4]. Based on previous studies, adherence to GH therapy ranges from 5% to 82% [5].…”

Section: Introductionmentioning

confidence: 99%

Adherence to growth hormone therapy in children and its potential barriers

Mohseni

Heydari

Qorbani

et al. 2017

Journal of Pediatric Endocrinology and Metabolism

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Background: One of the main concerns in chronic diseases such as growth hormone (GH) deficiency is adherence to the treatment, which significantly affects treatment outcomes. Methods: This cross-sectional study was conducted among 169 GH recipient children (2-12 years) and teens (13-19 years) referred to a GH distributing teaching pharmacy. The eight-item Morisky Medication Adherence Scale (MMAS) and auto-compliance method were used for the assessment of patients' adherence to GH. The potential barriers to GH therapy adherence and medication persistence were also explored. Results: Based on the MMAS method, 56.7% of the children and 57.9% of the adolescent groups were adherent to GH therapy. Conversely, according to the auto-compliance method almost all the patients were adherent in the children (95.2%) and adolescent (95.5%) groups. Forgetting to take the injection or refill the prescription, being away from home, exhaustion from long-term injection, drug shortage and inaccessibility to the pharmacy were barriers found to be significantly associated with a low adherence in the children group. While in the adolescent group, forgetting to take the injection, painful injection, concern about longterm complications and exhaustion from long-term injection revealed a significant association with low adherence. Persistence with GH therapy was reported in 75.3% and 67% of children and adolescent patients, respectively.

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“…Viceversa può essere utile suggerire loro di controllare il livello di pressione arteriosa o della colesterolemia per verificare l'efficacia della terapia. Per gli anziani però a volte è indispensabile anche il coinvolgimento dei familiari [26][27][28][29][30].…”

Section: Come Migliorare L'aderenzaunclassified

The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation

Scardi

Mazzone²,

Umari

2016

Monaldi Arch Chest Dis

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EDITORIALE IntroduzioneMolti studi randomizzati e controllati hanno definitivamente dimostrato l'efficacia dell'uso di acido acetilsalicilico (ASA), betabloccanti, ACE-inibitori (ACE-I) e statine per la prevenzione secondaria nei pazienti con cardiopatia ischemica. In conseguenza le linee guida raccomandano l'utilizzo routinario di questi farmaci [1][2][3]. Infatti, Goldberg et al. [4], usando i dati dello studio GRACE (Global Registy of Acute Coronary Events), su 26.413 pazienti senza controindicazioni alla loro assunzione, hanno rilevato, dopo l'implementazione delle linee guida, un deciso aumento dal 2000 al 2005 nell'assunzione di statine (dal 45% al 85%), ACE-I (dal 63% al 77%), betabloccanti (al 83% al 91%) e ASA (circa 95%).Nonostante i dimostrati benefici la terapia cardioprotettiva però è poco utilizzata per la scarsa aderenza dei pazienti: infatti il 20-50% risulta non aderente alla terapia medica cronica [5][6].L'aderenza alla terapia è la percentuale di farmaci e delle loro dosi, prescritte dai medici curanti, che i pazienti devono assumere con la stabilita frequenza e per un preciso periodo di tempo. A differenza della compliance (grado con cui il comportamento passivo di un paziente coincide con le raccomandazioni del medico), l'aderenza prevede il coinvolgimento attivo e collaborativo del paziente a cui si chiede di partecipare alla pianificazione e all'attuazione di un trattamento elaborando un consenso basato sull'accordo [7].L'aderenza è un fenomeno complesso che riflette l'interfaccia tra efficacia, tollerabilità, frequenza di somministrazione, interazioni fra preparati, effetti indesiderati e costi di eventuali tickets [8]. Nell'aderenza alla terapia è necessario rilevare anche il dosaggio dei farmaci assunti per il raggiungimento del target, perché solo in questo modo si ottengono benefici [2]. Gli aderenti alla terapia poi sono aderenti spesso anche alle modificazioni dello stile di vita [9].La prevenzione secondaria della cardiopatia ischemica è difficile a causa della politerapia (almeno 3-4 farmaci al giorno) che comporta regimi complessi con prescrizioni multiple e pluralità di somministrazioni in ore differenti della giornata. Ciò Migliorare l'aderenza all'assunzione dei farmaci per la prevenzione secondaria della cardiopatia ischemica: la prossima frontiera della riabilitazione cardiovascolare ABSTRACT:The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation. S. Scardi, C. Mazzone, P. Umari. Non-adherence to prescribed drug regimens is an increasing medical problem affecting physicians and patients and contribute to negative outcomes, such as the increased risk of subsequent cardiovascular events. Analysis of various patient populations shows that the choice of drug, its tolerability and the duration of treatment influence the non-adherence. Intervention is required toward patients and health-care providers to improve medication adherence. This review deals about the prevalence of n...

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Helping Patients Follow Prescribed Treatment

Cited by 765 publications

References 15 publications

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Adherence to growth hormone therapy in children and its potential barriers

The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation

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