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    Tuesday, June 23, 2009

    America's other drug problem

    The National Council on Patient Information and Education has termed medication nonadherence "America's other drug problem.”

    Approaches to improve adherence can be complex and labor intensive. The problem of medication nonadherence poses an even greater risk among elderly patients in the United States, among whom poor medication adherence is common, morbid, costly, and difficult to treat. And it is among the elderly, that polypharmacy, which is the use of multiple medications resulting in complicated drug regimens, is an important barrier to medication adherence. Of 4053 patients aged 65 years or older prescribed medications for hypertension and hyperlipidemia, the adherence to both classes of medication decreased rapidly to 40.5% at the 3-month interval, and then to 32.7% at 6 months.

    • The adherence rate for medical treatments [ or non-compliance rate] averages in some studies about 50%, with a range that extends from 0% to 100% .
    • A Physicians' estimates of their own patients' adherence have no better than “chance accuracy”.
    • Thus the problem of low adherence can be almost invisible to the individual practitioner dealing with a specific patient. This is true even for patients whom physicians feel they know well.
    • Thus, part of the problem of detecting low adherence is that clinicians often think they know a poor or good complier when they see one, perhaps cueing on such characteristics as age, gender, education, and intelligence—none of which have been shown to have any consistent relationship to adherence.
    • Adherence to chronic pharmacological therapies is poor.
    • This often leads to worsening disease severity and increased costs associated with higher hospital admission rates.
    • Barriers to medication adherence are numerous,and are particularly prevalent among the elderly population, placing them at increased risk for medication nonadherence.
    J. K. Lee et al noted that poor medication adherence diminishes the health benefits of pharmacotherapies, especially in elderly patients with coronary risk factors who frequently require treatment with multiple medications, placing them at increased risk for nonadherence.

    Of a total of 200 elderly patients, a pharmacy care program led to increases in medication adherence, medication persistence, and clinically meaningful reductions in BP, whereas discontinuation of the program was associated with decreased medication adherence and persistence.

    “Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol A Randomized Controlled Trial” published in JAMA. 2006;296: (doi:10.1001/jama.296.21.joc60162)
    Chapman RH, Benner JS, Petrilla AA, et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med. 2005;165:1147-1152.

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    1 comment:

    1. Medication compliance is a tremendously important topic. Here is an interesting approach to using two different technologies -- paper-based and telephone-based -- to solve the age-old behavioral problem of "taking your meds."