PPCC MOD 6

Compliance

ability to act accordingly to an order or request; following recommendations

Adherence

The extent to which a persons behavior such as taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed upon recommendations from a health care provider

Persistence

the act of continuing the treatment as prescribed

Issues with managing medications

• 30% of prescriptions may not ever be picked up (primary non adherence)

• adherence among patients with chronic conditions avg only 50%

• 8 out of 10 adults take at least one medication

System Impact

• cost increase

• employer cost increase

  (loss of employer productivity)

• unreached potential of healthcare advances; population health goals

• increase in nursing home and hospital admissions

Patient Impact

• morbidity (disease worsening)

• mortality (increased death)

• quality of life affected

• reduced treatment effectiveness

• withdrawal systems

• psychosocial complications

Types of Non-Adherence

1. primary- Rx never filled/picked up

2. secondary- Rx started but doesn’t continue

3. intentional- pt chooses not to take medicine

4. unintentional- omissions, delayed doses, additional doses, incorrect administration

5. “White Coat Adherence”

Predictors of Non Adherence

• psychological conditions

• presence of cognitive impairment

• asymptomatic disease states

• inadequate follow up or discharge planning

• medications with high side effect profile

• poor provider relationships

• barriers to taking the meds

Unintentional, Preventable NA

forgetting doses

• omitting doses

• not having meds when away from home

misunderstanding regimen demands

running out of meds

improper admin techniques

cost issues

feeling like med is unecessar

adherence measured

proportion of days covered PDC

PDC= (# of days in a period “covered”/ # of days in period) x 100%

PDC OF 0.8 IS GOOD

PDC OF 0.9 FOR HIV IS GOOD