Medication Adherence

DR.N.BHARATHI
ASSISTANT PROFESSOR
GNITC.
Medication Adherence :
Medication adherence is defined as “The extent to which a patient’s medication-
taking behavior coincides with the intention of the health care provider.”
 Doctors assume that when they give a prescription to a patient, the drug will
be taken, as directed.
 In many of the cases, patients do not follow the instruction regarding
prescribed drugs and results into no therapeutic response to given prescribed
drugs which indicate poor compliance.
 Hippocrates warned that patients may 'often lie about taking their medicines‘
Causes of medication non-adherence :
Non adherence may be voluntary or involuntary, and there are many reasons for patients not
taking their medications as prescribed.
 Forgot to take the medication.
 Fear of Adverse events.
 High cost
 Lack of Education
 Poor quality of life
 Busy Schedule
 Poor patient Physician Understanding
 Depression and Stress
 Since non adherence to antihypertensive medication is the main cause of uncontrolled blood
pressure , patient reported that he stopped his medicine when his BP was within acceptable
limits.
Pharmacist role in the medication adherence :
Effectiveness of therapeutic regimen depends upon both the patient adherence
and efficacy of medicine. Thus, healthcare providers as well as system have a
great role in improving the medication adherence. Improving in single factor
cannot provide 100% success rate in compliance.
Level of Prescribing:
For improving the compliance there is need to introduce two-way approaches
during prescribing the medicine.
Before prescribing the medicine, doctor should discuss or ask the patient for
convenient preparation/dosage form and according to feasibility doctor should
prescribe or change the treatment plan.
Communicating with the Patient: At the time of prescribing or dispensing of drugs, the health
practitioners should explain the key information such as what, why, when, how, and how long to
take medicine.
To improve the patient compliance then provide medication calendar, medication chart, drug
information sheet, special container indicating time of dose, etc.
Compliance may be improved in four ways:
By Ensuring Compliance:
Doctors and nurses can give single dose of drug, for example, gonorrhea can be treated by a
single dose of procaine penicillin.
By removing Barrier to Compliance:There are several barriers to compliance such as taste of
medicine, dosage form, side effects notice, etc. So, some strategy can be used to remove the
barrier to increase in medicines adherence.
By Simplifying Therapeutic Regimens:
Many times, patients avoid or discontinue using of drugs due to complex regimen. Doctors can
simplify the therapeutic regimen by reducing the number of tablets and frequencies of drug
administration. Doctors can prescribe combination of drugs in a single tablet. Frequent
administration of drug can be avoided by prescribing sustain dosage form or long acting drug. By
Educating the Patient:
In certain conditions (diabetes, tuberculosis, HN), compliance can be improved by educating the
patients about their disease condition and necessity of medicines for their treatment. Patient
education is always to be encouraged if it improves the compliance.
Patient can also be helped by providing the leaflets for drug information and instruction to take
the medicine particularly for ear drop, pessaries and suppository.
Monitoring of patient medication adherence:
Direct Method:
Measuring the concentration of the drug in body fluids (Direct
method). Measuring the pharmacological effect (Direct Method).
Indirect Method:
Tablet counting
Patient self report
Patient diaries
Recording devices
Refilliing of Prescription
Drug information services
Drug and Poison information centre:
 Drug information services (DIS) are the critically, relevant and currently
examined data on the drug and drug use for given patient or situation.
 Many of the organization run DIS and provide the drug information “from
any place to every kind or group of people”.
 The Major goal of the DIS is to improve the “patient care services and
providing the unbiased information for various drug related questions”.
 Employees working in the drug information services are “dedicated to
provide the written or oral information in response to request from various
health care professionals, organization, committee or patients about the drugs
and its pharmacotherapy”.
POISON INFORMATION CENTRE :
The Poisons Information Centre (PIC) is a specialized service or center
dedicated to involve in providing the information on the “Prevention,
diagnosis and management of poisoning”.
In most of the developed countries, there is established facility of poison
control center, analytical laboratory with poison information service and
facility of patient management.
In India, Department of Pharmacology of All India Institute of Medical
Sciences, New Delhi has established National Poisons Information Centre
(NPIC) in February, 1995.
 On the level of inquiries this center provides the “Toxicological information
and as well as guidance on the management of poisoned patients”.
 The sources of this NPIC are the systematic collection of huge data from
worldwide libraries on poisoning, drug reactions and management. This
information service is available round the clock.
 A poison control center is a rapid access and immediate medical facility center.
This center is able to provide the free and immediate expert opinion on
telephone for the assistance and management in case of exposure to poisonous
substances.
 The center also provides the information on medicines, domestic products,
pesticides, bites and stings, food poisoning and on fumes.
Sources of drug information:
Primary Sources: The primary source of drug information is undertaken by the authors without
accessing by second party. Such type of source provides current information about drug.
Examples: Articles published in journals (for example: New England Journal of Medical),
thesis, etc.
Secondary Sources: In this source, the originality of drug information has been evaluated by
second party other than the publisher. This type of information is modified and in rearranged
form. Examples; review articles such as lexis-nexis, Medline, etc.
Tertiary Sources: In this source, the drug information is collected from primary and secondary
sources and organized in a manner to represent a composite of the available information.
Examples; Encyclopedia, Dictionaries, text book, guides; official pharmacopeias such as BP,
USP, IP, BNF, etc.
Computerised services :
There is an important role of computer services in the basic pharmacy research and in the
development of following clinical pharmacy practices and services:
 Patient record Management.
 Entries of Medication Orders.
 Patient Medication Profile.
 Drug Therapy Monitoring and Problem Detection.
 Record of Drug-Drug Interactions and Adverse Drug Reactions.
 Pharmacy Automated drug interaction screening (PADIS) system. Inventory control.
 Medical Research.
 Computerizing Drug Information System. Teaching Techniques.
 Building Data Base.
Storage and retrieval of information :
 It is an organized process of collecting and classification of data so that the
information can be easily located and displayed on request.
 Use of computers and data processing techniques has made this possible to
assess the large amount of information for academic, government and
commercial purposes.
Types of Storage Media:
Hard Drive
Floppy Disc
CD and DVD
USB Flash Drive
Major Components of Information Retrieval:
Database
Search Mechanism
Language
Interface
PHARMACY AND THERAPEUTIC COMMITTEE :
 Pharmacy and Therapeutics committee (PTC) is a group of medical staff
and they perform advisory functions for the safety of patient's health.
 The PTC has a power to take decision about entry of new drug into hospital
formulary.
 Pharmacy and Therapeutic Committee (PTC) generally supervise all facets
of drug therapy in hospital or in an institution.
 The committee usually comprising a committee of healthcare providers
composed of physician, pharmacist and other health care professionals and
they provide the advisory functions and assist in the preparation of policies
regarding selection of drug, procurement.
Organization :

Composition of pharmacy and therapeutics committee may vary but mostly following
format is suggested for general approval. The PTC may be composed of:
•At least three physicians from various fields like; Internal medicine, Infectious disease,
Pediatrics, Surgery, Gynecology. One of the physicians may be appointed as the "Chairman"
of Pharmacy and Therapeutics Committee.
•Senior representative from hospital administration (hospital director) or similar designated
person and ex-officio member of committee.
•A representative of the nursing staff (mostly senior nursing staff may include).
•A pharmacist. The pharmacist is designated as the "Secretary" of the PTC.
The members of PTC should meet regularly at least recommended six times in a year and
whenever is necessary.
The committee can also call other persons which may be within or outside the hospital. The
rational for inviting such additional members is to contribution of specialized or unique
knowledge and skilled judgment in the meeting.
Functions :
 To select and make availability of drugs in accordance with the concept of
essential drugs.
 To recommend the procedures to procure the selected drugs and adopt the
criteria and procedures for the procurement of drugs.
 To estimate hospital drug requirements and manage the hospital drug budget.
 To define standards for prescribing drugs and related practical requirements.
 To make availability of drugs to all prescribers and dispensers unbiased
information on drugs.
 To organize information drives on drugs for the general public.
 To regulate commercial promotion of drugs at inside and outside the hospital.
 To inform all hospital staff members about all decisions taken by the pharmacy and
therapeutic committee.
 To conduct scientific studies to update and ensure rational use of drugs.
 To investigate periodically the morbidity and mortality statistics to determine
changes in their patterns, requiring changes in rational drug therapy.
 To monitor adverse drug reactions of drugs.
 To develop and implement dispensing procedures and practices.
 To design a strategy assuring the quality of the drugs and the pharmaceutical
services in the hospital.
 To develop and undertake educational activities on the rational! use of drugs.
 Committee has a power to make out and address conflict of interest issues which will
obstruct practitioner's capability due to financial or some other reasons.
 Policies of the pharmacy and therapeutic committee in including drugs
into formulary :
 Time is an essential factor in emergency situations, thus the PTC of a hospital
should prepare boxes of emergency drugs, and these boxes should always be
readily available for use at the bed -side.
 The list of such drugs and other supplies should be compiled by the policy of
the Committee, and should find their place in “emergency kits”.
Supplies to be Maintained in Emergency Box :
i) Syringes, two each of 1ml (i.e., tuberculin or insulin syringe), 2ml and 5ml
syringes, and one each of 10ml and 20ml syringes.
ii) Needles, two each of 16', 18', 20', 21', 23', and 26'.
iii) Files for breaking the ampoule.
iv) Tourniquets.
v) Airways equipment.
vi) Ryles tube.
Drugs for Emergency Box:
This list is prepared by consulting the physician:
i) Aminophylline.
ii) Amylnitrite glass capsules for inhalation. iii) Atropine sulphate (0.4mg/ml). iv)
Caffeine sodium benzoate (0.5gm/2ml). v) Calcium gluconate (1gm/10ml). vi)
Digoxin (0.25mg/ml). vii) Diphenylhydantoin sodium (50mg/ml). viii)
Epinephrine HCl (1mg/ml). ix) Heparin (10.000 units/ml).
Supplies for Cabinet Utility Room
i) Venous cannulation set.
ii) Each set of 12 and 17 venous catheters.
iii) Pieces 6'' shock blocks.
iv) Oxygen catheters.
v) Razor with blades.
vi) Package sterile gelatin sponge.
vii) Resuscitation tube.
Other Emergency Supplies
i) Resuscitation carts.
ii) Phlebotomy sets.
iii) Oxygen equipments.
iv) Tracheotomy sets.
v) Dextran and tubing. vi) Burn sheets.
Inpatient and outpatient prescription :
Prescription Requirements Given below are the prescription requirements as per
the policies of PTC:
1) The prescriptions should fulfil the legal requirements as per the Pharmacy Act
before dispensing a prescribed medication.
2) Telephone/Verbal Orders In accepting verbal or telephone orders, safety is the
prime principle. Verbal and telephone orders have a higher risk for errors as
the orders can be misheard, misinterpreted, and/or mistranscribed. Policy 1) A
registered nurse, licensed practical nurse, respiratory therapist, or a pharmacist
can accept verbal and telephone orders if the authorised prescriber (i.e.
physicians, nurse practitioners, dentists) cannot write them.
Automatic stop order :
Telephone/Verbal Orders In accepting verbal or telephone orders, safety is the
prime principle. Verbal and telephone orders have a higher risk for errors as the
orders can be misheard, misinterpreted, and/or mistranscribed.
Policy 1) A registered nurse, licensed practical nurse, respiratory therapist, or a
pharmacist can accept verbal and telephone orders if the authorised prescriber
(i.e. physicians, nurse practitioners, dentists) cannot write them.
THANK YOU