Pharmacology Book

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Medication Compliance

Aka: Medication Compliance, Medication Adherence, Medication Nonadherence, Medication Noncompliance, Medication Synchronization
  1. Epidemiology
    1. Chronic medications are not taken as prescribed in up to 50% of cases
    2. New medication prescriptions are not filled in up to a third of cases
  2. Approach
    1. Assess Medication Compliance at every visit (analogous to checking Vital Signs at each visit)
      1. Ask about problems taking medications and missed doses
      2. Review medication refill patterns with pharmacy if non-compliance is suspected
    2. New medications should receive focus
      1. Explain why the medication is indicated and for how long
      2. Anticipatory guidance on adverse effects
      3. Select Generic Medications or employ cost cutting methods (e.g. cut larger dose tablet in half)
    3. Encourage Medication Compliance through education
      1. Explain benefits of medication
      2. Review correct schedule of medication
      3. Discuss ways to reduce adverse effects
      4. Patient should be able to paraphrase the key education points in their own words
      5. Give an active, updated medication list at each visit (part of after visit summary)
    4. Employ reminder systems to take medications
      1. Use pill boxes
      2. Time medication delivery with daily activities
      3. Consider alarms or phone applications to issue reminders
      4. Consider mobile applications (e.g. Medisafe, Dosecast)
    5. Involve pharmacists
      1. Consider pharmacy consultants to review medications with patients
        1. May help to eliminate compliance barriers (e.g. cost, adverse effects)
      2. Patients should share their medication lists with their pharmacists
        1. Allows for screening for Drug Interactions and duplicate medication classes
      3. Perform Medication Synchronization
        1. Work with the pharmacist to synchronize refill dates so that all medications may be filled on the same date
        2. Will require some medications with a smaller number of pills dispensed (patient may need to pay extra)
    6. Involve others
      1. Involve family members to assist with Medication Compliance
  3. Associated Conditions: Disorders commonly complicated by Medication Nonadherence
    1. Cardiovascular conditions
      1. Hypertension
      2. Hyperlipidemia
      3. Coronary Artery Disease
      4. Congestive Heart Failure
    2. Endocrine conditions
      1. Diabetes Mellitus (e.g. Diabetic Ketoacidosis)
    3. Gynecology
      1. Oral Contraceptives
    4. Infectious Disease
      1. Antibiotic noncompliance overall is common (missed doses, stopping course early)
      2. HIV Infection (Antiretroviral therapy)
    5. Lung conditions
      1. Asthma
      2. COPD
    6. Neurologic conditions
      1. Migraine Headache
      2. Seizure Disorder
    7. Psychiatric conditions
      1. Major Depression
      2. Anxiety Disorder
      3. Bipolar Disorder
      4. Schizophrenia
  4. References
    1. (2014) Presc Lett 21(10): 59
    2. (2013) Presc Lett 20(12): 68-9

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