Medication non-adherence in a cohort of chronically ill Australians: A case of missed opportunities

Abstract

MULTIMORBIDITY is common. It affects not only individual patients but also households and health services. 1 Approximately half of patients with multimorbidity do not take medications appropriately, partly because of polypharmacy. 2 The range of effective medications for each disease can be confusing, especially when the patient takes medications for several illnesses. Added to this, potential barriers to adherence relate to the delivery, governance and financing of healthcare. 3 Optimal care for multimorbidity requires carers in several disciplines. 1,4 In Australia, general practice plays a key role in coordinating care. 5,6 The Federal Government reimburses patients or general practitioners (GPs) and some allied health practitioners on a fee-for-service basis. 7 Reimbursements are available for GPs' preparation and review of disease management plans and for the review of multidisciplinary care arrangements ('Team Care Arrangements'), which facilitate subsidised access to nonmedical healthcare providers. In addition, payments are available for GPs and pharmacists for comprehensive and collaborative Domiciliary Medication Management Reviews (DMMRs) and Residential Medication Management Reviews (RMMRs). The impact of these services on medication adherence by people with multiple chronic diseases in Australian clinical practice is unclear. Recently, the Australian Government announced a pilot trial of coordinated care, delivered by multidisciplinary teams in general practice, for patients with chronic and complex conditions. 8 Health Care Homes are funded via bundled, rather

Non‐prescription medicines may contribute to non‐adherence to prescription medicines in people living with chronic health conditions

“…In contrast, Australian studies by Laba et al and Al‐Ganmi et al found no significant correlation between non‐adherence and demographic factors . Both Laba et al and Al‐Ganmi et al also found no correlation with non‐adherence and therapy‐related factors . These are consistent with findings from the review by Gast and Mathes which found mostly no impact on adherence by therapy intake regimen .…”

“…Similar to this, reviews of non‐adherence literature have found an association with age, education and employment . In contrast, Australian studies by Laba et al and Al‐Ganmi et al found no significant correlation between non‐adherence and demographic factors . Both Laba et al and Al‐Ganmi et al also found no correlation with non‐adherence and therapy‐related factors .…”

“…Studies relating to medication adherence in an Australian population are currently limited. To date, four studies have investigated factors investigating medication adherence in an Australian population; however, these involved only a small sample size of less than 250 participants . As such, non‐adherence needs to be further explored in the Australian context including assessing the impact of factors such as the number of CHCs and polypharmacy.…”

Does the national competency standards framework for pharmacists in Australia support the provision of behaviour change interventions?

“…Medication non‐adherence is a leading cause of multi‐morbidity in chronic disease suffers in Australia 20 . Although the core obligation of a pharmacist's role is the provision of advice and information about medicines, for safe and effective use, 21 research has shown that pharmacists rarely question patients about adherence and offer limited services to improve it 19 .…”

“…8,19 Medication non-adherence is a leading cause of multi-morbidity in chronic disease suffers in Australia. 20 Although the core obligation of a pharmacist's role is the provision of advice and information about medicines, for safe and effective use, 21 research has shown that pharmacists rarely question patients about adherence and offer limited services to improve it. 19 This has been attributed to barriers such as a lack of time, remuneration and inadequate training in motivational and cognitive-based behaviour change techniques to appropriately guide patients.…”