(2) Patient adherence, compliance and concordance
Pharmaceutical care
It is the responsible providing of drug therapy to achieve certain outcomes that improve patient’s QOL.
These outcomes include:
Curing the disease
Elimination or reduction of patient’s symptoms
Arresting or slowing disease progress
Preventing the disease or other symptoms
It includes the determination of a patient’s drug needs and providing all services required before, during and after treatment to assure safe & effective therapy. This includes a feedback mechanism.
Principles for practice of pharmaceutical care
A professional relationship must be established and maintained.
It is based upon care, trust, cooperation, etc.
The pharmacist provides their professional knowledge and skills for the patient’s welfare, while the patient agrees to supply personal info. & preferences.
The pharmacist develops mechanisms to ensure the patient has access to pharmaceutical care at all times
Patient-specific medical information must be collected, organized, recorded, maintained, and evaluated.
Data collected include:
Patient’s general health & activity status
Past medical & medication history
Social history & economic situation
Diet & exercise habits
Sources of data collection
Medical charts and reports.
The patient, their family or caregiver, insurer.
Other healthcare providers including physicians, nurses, and other pharmacists.
A drug therapy plan developed mutually with the patient.
The pharmacist assures that the patient has all supplies, information and knowledge necessary to carry out the drug therapy plan.
The pharmacist reviews, monitors, and modifies the therapeutic plan as necessary and appropriate, in concert with the patient and healthcare team.
Everything must be documented as proof of action.
Medication history taking
For current prescription medication | Drugs taken on an “as needed” basis (PRN) need to be quantified acc. to how often the patient actually takes the medication. |
Current non-prescription medications | They can interact and cause ADE with prescription meds, so their information is obtained. They include herbal products & vitamins. |
Past prescription and non-prescription medications | As much information as possible of past drugs is obtained, and why the patient stopped taking them. Helps the pharmacist understand what past ttt were successful or not. |
Allergies | Ask if the patient has allergies to any medication or food. If a drug allergy is identified, the pharmacist should ask the patient the date of the reaction, what was used to treat it, etc. |
ADR | Ask about past experienced medication side effects. If an adverse drug reaction is identified, the pharmacist should obtain the name of the medication, the dosage, the frequency, and how it was managed (dosage decreased, drug discontinued, etc.). |
Medication adherence
Adherence: The extent to which patients follow the recommendations of their healthcare providers. (Active patient in decision making)
Compliance: The degree to which a patient correctly follows medical advice. (passive)
Concordance: collaborative approach to medication management, stressing on shared decision-making between the patient and healthcare provider. (Active)
Medication adherence is not exclusively a patient’s responsibility. It could also involve the physician and other healthcare professionals (ensuring ease of medication taking process, etc.)
Identification of non-adherence is challenging and requires specific interviewing skills.
Causes of medication non-adherence:
Fear—Cost—Misunderstanding or miscommunication—ADRs—Polypharmacy—Lack of symptoms—Depression