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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5739_Библиотеки_им_академика_М_И_Перельмана.pdf
Pharmacy Practice78
4. TDM exists in large teaching hospitals in department of:
A. Pharmaceutics
B. Chemistry
C. Clinical pharmacology
D. Biotechnology
AnswersAnswers
AnswersAnswers
Answers
1. Minimum effective concentration
2. MEC (desired) to MEC (adverse) 3. B 4. C
Medication adherence, or taking medications correctly, is
generally defined as the extent to which patients take medi-
cation as prescribed by their doctors. It includes getting
prescriptions filled, remembering to take medication on time,
and understanding the directions prescribed. There are some
common barriers to medication adherence
• Economic, i.e. inability to pay for medications
• Disbelief that the treatment is not necessary
• Difficulty in taking multiple medications and complex
dosing schedules
• Confusion about how and when to take the medication
A simple example is of taking antibiotics. After taking
antibiotics a patient feels better and no longer have symptoms,
he may think that the illness is cured. If still have a bacterial
infection, this can be a dangerous assumption and can lead to
antibiotic resistance, if the prescribed course of antibiotics is
not taken, chances are there that small number of bacteria may
still be alive. These surviving germs are likely to have some
natural resistance to the antibiotic. As they multiply and spread,
a new strain of resistant germs may begin to develop.
It is important to use antibiotics appropriately and to take
the medication exactly as directed.
• Take all doses of the antibiotic, even if the infection is getting
better.
• Do not stop taking the antibiotic unless doctor tells to do so.
• Do not substitute the antibiotics with other antibiotics.
Medication Adherence
8
Pharmacy Practice80
Medication adherence is the voluntary cooperation of the
patient in taking drugs or medicine as prescribed, including
timing, dosage, and frequency. Approximately 20–50% of
patients are nonadherent to their medications. Nonadherence
to medication for chronic diseases leads to worse therapeutic
outcomes, higher hospitalization rates, and increased health
care costs. Patients with chronic conditions often must take
more than one medication indefinitely for maintenance, and
their adherence to their therapeutic regimen tends to decrease
over time.
Nonadherence may be voluntary or involuntary, and there
are many reasons for patients not taking their medication as
prescribed.
CAUSES FOR NONADHERENCECAUSES FOR NONADHERENCE
CAUSES FOR NONADHERENCECAUSES FOR NONADHERENCE
CAUSES FOR NONADHERENCE
Nonadherence means not taking the medicines properly. There
are various reasons for nonadherence like:
• Not taking medication, i.e. forget to take medicine
• Fear of adverse events or a negative attitude toward
medications
• High cost
• Lack of education
• Poor quality of life
• Busy schedule
• Poor patient–physician understanding
• Depression and stress
• Since nonadherence to antihypertensive medication is the
main cause of uncontrolled blood pressure (BP), patient
reported that he stopped his medicine when his BP was
within acceptable limits.
ROLE OF PHARMAROLE OF PHARMA
ROLE OF PHARMAROLE OF PHARMA
ROLE OF PHARMA
CISTCIST
CISTCIST
CIST
Once the reasons for nonadherence have been identified, the
pharmacist can intervene to help the patient by improving
adherence, including counseling, patient education, and telling
about importance of medication.
• Helping the patient in decision-making
Medication Adherence 81
• Simplifying the medication regimen through once-daily
dosing formulations can result in as much as twice as many
adherent days versus more complex dosing.
• Improving the patient–physician relationship is a
commonly proposed means of enhancing compliance.
• A patient’s attitude may also affect his or her adherence.
• The pharmacist must approach each patient individually to
determine the level of adherence and what barriers may
exist that are preventing the patient from taking his or her
medication appropriately.
• Education, while helpful, is usually not enough to persuade
the patient to comply with the physician’s drug orders.
• Information must be presented in clear, easy-to-understand
language, and the patient must understand not only
the benefits of adherence but also the repercussions of
nonadherence.
• When filling a prescription, the pharmacist should do a
quick review to see whether the dosing schedule is as simple
as possible.
• The pharmacist should inquire frequently about any
adverse effects the patient is experiencing and then consult
the physician regarding suggested alternatives.
STRASTRA
STRASTRA
STRA
TEGIES TO IMPROTEGIES TO IMPRO
TEGIES TO IMPROTEGIES TO IMPRO
TEGIES TO IMPRO
VE THE PHARMAVE THE PHARMA
VE THE PHARMAVE THE PHARMA
VE THE PHARMA
CISTCIST
CISTCIST
CIST
––
––
–
PP
PP
P
AA
AA
A
TIENTTIENT
TIENTTIENT
TIENT
RELREL
RELREL
REL
AA
AA
A
TIONSHIPTIONSHIP
TIONSHIPTIONSHIP
TIONSHIP
• Be friendly and approachable to the patient.
• Improve communication skills.
• Improving patient education.
• Give clear explanation.
• Check the patient understanding.
• Monitor the side effects.
• Simplify the therapeutic regimens.
• Speak the same language of patient.
• Monitor the beneficial effects.
• Involvement of patient treatment discussion.
MEDICAMEDICA
MEDICAMEDICA
MEDICA
TION ADHERENCE MONITORINGTION ADHERENCE MONITORING
TION ADHERENCE MONITORINGTION ADHERENCE MONITORING
TION ADHERENCE MONITORING
Full adherence to medication is required as the drug can be
effective only when it is taken. Maintaining strict medication
Pharmacy Practice82
adherence is required that deems maintaining administration
timing, dosage quantity, and frequency. A wealth of reports
revealed that up to 50% of the patients either never fill their
medication prescriptions or do not use the medication as
prescribed to them in medication regimens. Unfortunately,
poor adherence is prevalent among populations with chronic
illnesses, which leads to hospital admission. In the US alone,
poor medication adherence results in more than 100,000
mortalities annually, as well as hundreds of billion dollars of
healthcare spending every year. A number of approaches have
been used for the aim of monitoring medication adherence
because it has been shown that improving adherence to medical
therapy would substantially lead to both health and economic
benefits. In general, two key factors should be considered when
discussing medication adherence. The first factor is monitoring,
which is alternatively referred to as assessment, quantification,
measurement, or evaluation. Medication monitoring means
using some methods for observing if the patient has taken the
medication or not. Hence, the effectiveness of the monitoring
method plays a central role. The second factor is intervention.
Interventions refer to the means that can be used for improving
adherence to medication or correcting it once erroneous or drift
is detected. However, the latter is more in the domain of the
psychological and social sciences as it requires understanding
the cultural, psychological and social factors that affect the
patient’s behavior, and thus it is out of the scope of this paper.
Methods that have been utilized for measuring medication
adherence so far can be broadly divided into two categories,
direct and indirect. Direct methods of measurement of
adherence include direct observation of the patient while taking
the medication, laboratory detection of the drug in the biologic
fluid of the patient (i.e. blood or urine), laboratory detection of
the presence of nontoxic markers added to the medication in
the biologic fluid of the patient, and laboratory detection of
the presence of biomarkers in the dried blood spots. Direct
measures are accurate, but they may require invasiveness, and
they are usually expensive. In comparison, indirect methods
are less expensive and provide good estimation of the
Medication Adherence 83
medication adherence. However, these methods relay on the
reliability of the user. As such, these factors should be taken
into consideration when selecting the adherence measurement
methodology.
ISOLISOL
ISOLISOL
ISOL
AA
AA
A
TED KEY POINTSTED KEY POINTS
TED KEY POINTSTED KEY POINTS
TED KEY POINTS
• Medication adherence, or taking medications correctly, is
generally defined as the extent to which patients take
medication as prescribed by their doctors.
• Some common barriers to medication adherence
i. Economic, i.e. inability to pay for medications
ii. Disbelief that the treatment is not necessary
iii. Difficulty in taking multiple medications and complex
dosing schedules
iv. Confusion about how and when to take the medication.
• Medication adherence is the voluntary cooperation of the
patient in taking drugs or medicine as prescribed, including
timing, dosage, and frequency.
• Nonadherence means not taking the medicines properly.
There are various reasons for nonadherence like:
i. Not taking medication, i.e. forget to take medicine
ii. Fear of adverse events or a negative attitude toward
medications
iii. High cost
iv. Lack of education
v. Poor quality of life
vi. Busy schedule
vii. Poor patient–physician understanding
viii. Depression and stress
• Since nonadherence to antihypertensive medication is the
main cause of uncontrolled blood pressure (BP), patient
reported that he stopped his medicine when his BP was
within acceptable limits.
• Medication adherence monitoring is required as the drug
can be effective only when it is taken. Maintaining strict
medication adherence is required that deems maintaining
administration timing, dosage quantity, and frequency.
Pharmacy Practice84
PRAPRA
PRAPRA
PRA
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONS
VV
VV
V
erer
erer
er
y Shory Shor
y Shory Shor
y Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. What do you understand by the term medcation adherence?
2. What is medication non-adherence?
3. Write two causes for non-adherence.
4. What is medication adherence monitoring?
ShorShor
ShorShor
Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Write different factors affecting medication adherence.
2. Enumerate the various causes for medication non-
adherence.
3. Describe the role of pharmacist in improving medication
adherence.
4. Write a short note on medication adherence monitoring.
LL
LL
L
ong Answer Tong Answer T
ong Answer Tong Answer T
ong Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Define medication adherence. Write its significance with
examples.
2. What is non-adherence. What are the causes of non-
adherence?
3. Explain the crucial role of pharamacist in:
a. Medication adherence
b. Overcoming the problem of non-adherence.
Objective TObjective T
Objective TObjective T
Objective T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Taking prescription medication correctly is known as
A. Medication adverseness B. Medication adherence
C. Medication avoidance D. Medication attentiveness
2. What are the common barrier to medication adherence
A. Economic, i.e. inability to pay for medications
B. Disbelief that the treatment is not necessary
C. Both a and b
D. None of these
3. Percentage of people that are non-adherent to their
medications:
A. 20–30% B. 10–20%
C. 30–40% D. 5–10%
Medication Adherence 85
4. What do you mean by non-adherence?
A. Patient forgetful about adhering to treatment regimen
B. Aware about the treatment and medications
C. When patient needs medicines
D. None of these
5. ________ is generally defined as the extent to which patients
take medications as prescribed by their doctors.
6. According to a report, ______ of the patients either never fill
their medication prescriptions or do not use the medication
as prescribed to them.
AnswersAnswers
AnswersAnswers
Answers
1. B 2. C 3. A 4. A 5. Medication adherence
6. 50%
The medication history interview is an important information
which a pharmacist used to gather information and implement
to improve overall patient health. It helps the pharmacist to
know about the patient’s medication, experiences and sharing
this valuable information with other health care professionals
for the betterment of patient.
Patient medication history is a detailed, accurate and
complete account of all prescribed and non-prescribed
medications that a patient had taken or is currently taking.
It gives important information regarding patient’s allergic
tendencies, adherence to pharmacological and non-pharma-
cological treatments and self medication with complementary
and alternative medicines. The process of interrogating a
patient in collecting the data and its medical history is called
patient medication history interview (PMHI).
A medication history is a detailed, accurate and complete
account of prescribed and non-prescribed medication. It
provides complete information about patient medicines that
had taken or is currently taking prior.
NEED FOR PANEED FOR PA
NEED FOR PANEED FOR PA
NEED FOR PA
TIENT MEDICATIENT MEDICA
TIENT MEDICATIENT MEDICA
TIENT MEDICA
TION INTERVIEWTION INTERVIEW
TION INTERVIEWTION INTERVIEW
TION INTERVIEW
The aim of medication history interview regarding of drug use
that may assist in overall care of patient. A good medication
history should encompass all currently and recently prescribed
drugs, previous adverse drug reaction including hyper-
sensitivity reaction, any over-the-counter medication.
Patient Medication
History Interview
9
Patient Medication History Interview 87
The information gathered can be utilized:
• To verify medication history taken by other staffs and
provide additional information
• Where appropriate.
• For screening of drug interactions.
• To assess patient medication compliance.
• To examine the needs for medication aids.
• For preventing prescription errors and consequent risks to
patients.
IMPORTIMPORT
IMPORTIMPORT
IMPORT
ANCE OF PMHIANCE OF PMHI
ANCE OF PMHIANCE OF PMHI
ANCE OF PMHI
Medication histories are important in preventing prescription
errors and consequent risks to patients. Apart from preventing
prescription errors, accurate medication histories are also useful
in detecting drug-related pathology or changes in clinical signs
that may be the result of drug therapy. Obtaining an accurate
medication history is an essential part of medicine
reconciliation. Such histories usually consist of a list of all
medicines (prescribed and purchased) that a patient was taking
prior to their admission to hospital.
• Helps in preventing prescription errors and consequent risk
to patients.
• Helps in detecting drug-related pathology or changes in
clinical signs resulting due to drug therapy.
• It should encompass all currently and recently prescribed drugs,
previous adverse drug reactions including herbal or alter-
native medicines and adherence to therapy for better care plan.
GoalsGoals
GoalsGoals
Goals
Goals of medication history interview is to obtain information
on aspects of drug use that may assist in over all care of patient.
This information obtained helps in:
• Compare medication profile with the medication adminis-
tration record and investigate the differences.
• Verify medication history given by other staffs and provide
additional information where appropriate. The following
information is commonly recorded:
i. Currently or recently prescribed medicines
ii. OTC medication taken