Medication Adherence in Various Patient Groups
While there are many common themes in medication adherence, there are some special considerations for different patient groups.
Medication Adherence in Diabetes
The goal of medication regimens in diabetes is to improve blood sugar control to prevent complications. Type 2 diabetes accounts for 9 out of 10 cases, and is the result of insulin resistance. Without proper management with lifestyle behaviors such as diet and exercise, the WHO asserts that most patients eventually need medications. Diet, exercise, monitoring, and medications are the cornerstones of management.
These are some facts related to diabetes self-management.
· Only 1 in 4 patients follow a physical activity plan and only 1 or 2 in 3 are adherent to a diet plan.
· As few as 1 in 3 patients regularly monitor blood glucose at home.
· Adherence ranges from 15 to 80%, with non-adherence including taking extra doses and skipping doses.
· A greater self-efficacy, better stress management, and better support are all linked to improved adherence.
Medication Adherence in Schizophrenia
Schizophrenia is a condition in which the patient has an altered perception of the world that can include untrue beliefs or hearing voices that are not there. Treatment usually includes psychotherapy and medications such as antidepressants, antipsychotics, and anti-anxiety drugs. As in other long-term conditions, such as diabetes and hypertension, patients are less adherent as their diagnosis is further in the past, and only about 1 in 4 continue to take medications properly.
· There are no immediate consequences for skipping doses, so patients may not understand the significance.
· Patients often skip up to half of doses due to forgetfulness.
· Side effects can cause patients to stop taking their medications.
· Family and social support can improve adherence.
HIV Medication Adherence
Medication adherence in patients with HIV/AIDS is particularly challenging. Adherence of at least 95% is required for best results, but the WHO reports that only 1 out of 3 patients take their medications properly, even when they understand the importance of highly active anti-retroviral therapy, or HAART, in preventing progression of HIV/AIDS. Even slight non-adherence can allow viral cell loads to increase, and infectiousness can also increase with non-adherence.
These are some challenges:
· The drug regimen is complex, with multiple doses per day and possible food restrictions.
· Side effects can be unpleasant and include nausea, diarrhea, and neuropathy.
· Substance abuse is a predictor of non-adherence.
· Social support and patient-provider trust can help in adherence.
Medication Adherence in Hypertension
Estimates vary from 20 to 80%, but what is clear is that many hypertensive patients are non-compliant. Consequences include a higher risk of stroke, coronary heart failure, dementia, reduced renal function, and blindness.
· Hypertension is largely asymptomatic, so motivation to adhere can be lower because medications do not make patients feel better.
· The biggest cause of uncontrolled hypertension is non-adherence.
· Low understanding of hypertension and its risks may contribute to non-adherence.
· Hypertension drugs can be complicated to take.
Medication Adherence in COPD
Chronic obstructive pulmonary disease, or COPD, is a progressive chronic disease that makes breathing difficult and is the fourth most common cause of death in the U.S. Medication adherence issues in patients treated for COPD include periods of symptom remission and the long-term nature of the disease. In addition, side effects can be severe. Only about half of COPD patients are adherent to their prescribed regimen.
Lark health coach can assist with adherence to the medication regimen in a number of ways.
· Connecting patients devices, such as inhalers and blood pressure cuffs, to measure usage and trends.
Reminding patients to take their medications: when and how much.
· Connecting patients to healthcare providers when needed.
· Educating patients on the importance of medication adherence.
· Tracking patient adherence so patients can see how well they have been following doctor’s orders.
In addition, Lark provides coaching to encourage healthy behaviors, including weight management, nutritious eating, getting active, and getting enough sleep. These behaviors can all support general well-being as well as increase patient self-efficacy in taking charge of health and staying adherent to medications to stay as healthy as possible.