Medication Compliance & Adherence

It appears that once we can address the problem factors that contribute towards compliance (ability and willingness) to take medications then it is more likely that adherence (maintaining doctors/pharmacist recommendations over period of time) would be appreciated.

So what are some of the consequences of non-adherence?

• Numerous negative consequences arise from

non-adherence.

• economic and health related downfalls are not always as obvious but are very predominant.
• switching to alternative herbal therapy usually has more negative long term consequences.
• 5 areas of adressing adherence; social & economic, health care system related, condition related, therapy related & patient related factors are considered.
• family/group help, calendars, phone reminders, simpler medications, pill boxes, talking with doctor/pharmacist/nurse, cultural disposition & education & physical well being & improvement are included.

Conclusion

Milena Flament

Medication Compliance & Adherence

By

DOODNATH ALFIE MOHAMMED

Other

Pharmacist & National Education Officer DATT

Diseases

Chronic Disease Statistics

in

Trinidad

high Blood Pressure

29.8% males, 23.1% females

obesity 55.7%

population

Cholesterol

28.3% males, 18.9% females

We have the highest prevalance of mortality (death) and morbidity (complications) arising from None Communicable Chronic Diseases (NCCD) in the Caribbean.

Cancer & Diabetes = 12-13%

Heart Disease 25%

Stroke 10%

NCCD = 60% Deaths in People < 70 Years

Compliance Vs Adherence

Drug Therapy Problems

What factors contribute to non adherence?

Adherence

These medications must have met requirements for being safe, effective & appropiate for you

Compliance is when you are both able to and willing to take prescribed or recommended medications.

WHO 2003- It is the extent to which a person's medication taking behaviour corresponds to the recommendation from health care provider over period of time

Medical conditions come in bunches

But it's easier said than done

Diabetes in Trinidad 15-64yrs

Overall Prevalance in Trinidad 12-13%

The human brain prefers short term rewards over long term rewards.

14.5% are Insulin Users

74.3% are on oral medications

health related behaviour hardly ever produces motivation for you to take your pressure or diabetes tablets as the results are not seen or felt right away

Bananas Don't Grow Alone

We therefore do not really value medication as much

Instead we prefer short term rewards

cash pot

play whe

lotto

So what happens to our medications?

Ask the little old woman

There was a little old lady from bamboo no.2,

She had so many meds, she didn;t know what to do,

she had 1 for cholesterol, 2 for sugar, and 3 for pressure,

and she had to cook & clean and would sit down in her leisure.

So she went next door & visited her neighbour,

and shared her meds & said "here gyul ah felling much betta"

ah week later her neighbour called out to her but she never spoke,

sadly, the little old lady had suffered a stroke

but we must first look at some examples of medication non-adherence

so lets talk about improving medication adherence then

• failing to initially fill a prescription
• failing to full a prescription as directed
• omiting a dose or doses of medications
• taking more medication than prescribed
• prematurely discontinuing medication
• taking a dose at the wrong time
• taking medication prescribed for someone else
• taking medication with prohibited foods & drinks
• or liquids unauthorised e.g. grapefruit juice with simvastatin or nifedipine. Alcohol & diabetic or high blood pressure medications.
• taking expired medications
• storing medications improperly
• improperly using medication devices as inhalers or eye drops

LET'S TAKE A CLOSER LOOK AT NON-ADHERENCE

Herbal Switching???

cinnamon

Diabetes Incidence

336 million worldwide

• no proven working ability of any herbal therapy
• they appeal to you because claims of natural imply no side effects
• but they have many side effects and interactions
• they do not improve long term benefits but bring symptom relief
• increased incidence of dialysis, surgery, blindness
• cannot cure anything just mask symptoms e.g. sure cure omega-3
• can be more costly, unsafe and gives only false promises due to advertising; radio/tv press etc

3 new diagnosis every 10secs

World distribution of diabetes

5-7%

7-9%

9-12%

>12%

Trinidad & Tobago has one of the highest % of diabetes in the caribbean

urban area 172m, 119m in rural

by 2030 314m & 143m resp'y

8.3% of adult population

Charity Temple

Think again!!

sure cure to all diseases

stamina man

It affects the economy & our health care-system

http://prezi.com/qu3ogkdnh5vb/prezume-of-charity-temple/

panax ginseng

Stuart Taylor, et. al

Well maybe we could

switch to herbs

Milena Flament

Consumer

$290 Billion spent on improving

medication adherence in US/yr

karalli

https://prezi.com/xwja941po289/wonderland/

http://prezi.com/ybzhchzydmq6/milenas-prezime/

95 million Americans do not take meds

• 100 billion dollars extra has to be spent on hospitalization
• 30% of those being re-hospitalized are diabetics.
• similar % for hypertension and heart disease
• tax payer dollars like your self being wasted to sustain your own demise which could have been used more fruitfully to improve status of health care system

John Wilson

https://prezi.com/7zvirx7ckytt/a-colonial-commencement/?auth_key=9360a17bf756177ddd042f577de0baaac0f65c90

Health Risks:

• Death rate from diabetes and heart disease patients when they are none compliant
• Increased risks of strokes.
• Unpredictable changes in blood pressure
• increased incidence of kidney failure and blindness
• sleeping disorders, depression
• poor quality of life and lower lifespan (unable to see grandchildren/great grand)

DIMENSION 1

Social & Economical Factors

Poverty

Family & children

Explaination

• English proficiency; some may not be able to read or write or understand what you are saying. Take 1 teaspoon 3 times a day or shake well before use, or take before meals.
• this results in inability to remember, unsafe practices. More verbal discussion is therefore needed
• poor social structure; poverty, unable to buy meds, travel, may prevent you from acquiring meds.
• dependent children, lack of family support and no social groups.
• busy work schedules, chores.

Solutions

literacy

• Have clearer bigger more legible labels. Repeat what you understand from doctor and pharmacist.
• Use pictures or diagrams to help you understand better.
• Involve family members or get involved in groups like Diabetes Association, churches.
• perform regular eye tests, hearing tests, monitor kidney function, x-rays for arthritis etc.

culture

DIMENSION 2

Health Care System Related Factors

SO IF WE WERE TO SUMMARIZE SOME

OF THESE POINTS THEN....

Access to health care and relationship with health professionals.

Daniel Kraft MD

Non Communicable Chronic Diseases account for vast majority of deaths across the world.

Trinidad ranks near top 20 nations with highest incidence of diabetes and deaths from heart disease

Medication compliance & adherence usually go hand in hand where one is just an extension of the other

Peter Diamandis

TEDMED

Abundance - The Future is Better Than You Think

TED 2012

• usually poor access to health in rural areas via transportation etc results in inability to keep appointments and leads to poor adherence.
• Less time spent talking with doctors because they are so busy.
• No information received on drug uses, side effects, interactions.
• Solutions
• be more involved in managing your own health, ask questions, talk with your pharmacist or nurse who has more time.
• involve family and groups. Travel together.
• call the pharmacy.
• stick to your appointments, write the dates, abide by instructions

http://prezi.com/g4_rsqna6kvl/abundance-the-future-is-better-than-you-think/

Problems

& Solutions

A Brief History of Life

by: David Knuffke

http://prezi.com/_zjirtmsoxrb/tedmed-2011-daniel-kraft-md/

DIMENSION 5

Patient Related Factors

http://prezi.com/boa21ytdaoxy/ap-bio-evolution-6-brief-history-of-life/

Behavioral and personal beliefs

Cultural & psychological.

Do you believe in conventional medicine?

Do you want to be treated?

Chip Conley

SXSW 2012

Are you willing to be treated by working

with doctor/pharmacist/professional?

Emotional Equations

http://prezi.com/u1401xeapltd/emotional-equations/

Can you physically muster up the strength

to carry on? Or are you just waiting for

your time?

Leticia Britos Cavagnaro

• If you have physical disability recognize and accept that you do and seek help. Test eyes and hearing.
• Use pictures and calendars and reminder aids to make life simpler.
• Self empowerment brings about motivation.
• Simple things like pre-filled syringes, liquid instead of tablets, pill organizers, sticky notes, and involving families are to be considered.

Street Artist - "JR"

Inside Out Project

TED 2012

Conference

Stanford

d.school

http://prezi.com/xe5thxwgcxz1/if-you-put-it-that-way/

DIMENSION 3

Condition Related Factors

http://prezi.com/row6dzyapfic/jr-inside-out-project/

Problems

Depression, alzehmiers, arthritis, & the entire

having to treat and manage yourself is time

consuming and boring & requires effort.

Solutions

pill boxes

Remember that due to other conditions existing simultaneoulsy it may be difficult to focus on any or all. Visiting a psychiatrist or counselor for depression or physiotherapist for arthritis may help improve your quality of life and you are more likely to adhere to medication regimen.

Tim Berners Lee

Doodnath Alfie Mohammed

Set alarms

Use phone reminders

National Education

Officer DATT

World Economic Forum

Annie Escobar

side effects

DIMENSION 4

Therapy Related Factors

Your Story Can Change the World

Davos 2010

QUESTIONS?

Vice President

The Pharmaceutical Society

Trinidad & Tobago

Start-Up Weekend

http://prezi.com/ptve2tu78evu/your-story-can-change-the-world-master/

Long duration with no rewards

Complex therapy to many drugs

look alikes, sound alikes

Interactions

http://prezi.com/r5ldr20rbl3o/swedu-bay-feb-24-26/

Brand & generics

Use simpler regimens

Like slow release once daily

medications

Use pill cutters to administer

more precise dose

ask about how to reduce side

effects, interactions

medications are arguably the single

most important health care technology

to prevent illness, disability & death

especially in the older population. Non

communicable chronic disease (NCCD)

patients benefit the most from taking their

medications and risk the most from failing

to take them properly.