Timothy E. Gibbs, BA, NPMcExecutive Director, Delaware Academy of

Medicine

Objectives

At completion of this presentation the audience will understand:

1.The importance of drug regime compliance2.How adherence and compliance are similar, yet different3.Identifying barriers to, and negotiating adherence with patients needing medication.4.How non-compliance is similar to drug “abuse”

An estimated 50% of all patients do not take medications properly:

•Right dose,

•Right time,

•Right conditions

When patients are asymptomatic . . .

Non-compliance rates increase dramatically to an estimated 75% percent.

Providers tend to OVERESTIMATE medication

compliance

Compliance and AdherenceSimilar meanings, but different connotation:

“Comply” means something like “Do what I tell you”

“Adhere” means something like “Stick to the plan”

The word “Compliance” defines

•A power dynamic between provider and patient

•Patient has less control

•Patient has greater opportunity to “fail”

When patients fail to COMPLY—

Blame is placed on the patient rather than the provider.

Barriers to Adherence

•Economic•Social•Behavioral•Environmental•Cultural•Biological

Barriers to Compliance:

Confusing and conflicting drug regimes may be a substantial barrier.

Recognizing Another Barrier

Healthcare Provider-Patient RelationshipMust be based on mutual respect and trust . . .

Adherence is Improved if a Patient:

• Takes part in negotiating the treatment plan

• Understands the disease and treatments

• “Buys into” or believes in the treatment plan

When patients believe in the Treatment Plan

•They adhere to the medication regime AND

•They seek out support for lifestyle changes, like

•DIET

•EXERCISE

Providers Need to

LISTEN to and ADDRESS patients’:•Fears•Lifestyle concerns•Social and family issues

TEACH patients about:•Disease process•Medication side effects

Opportunities to reduce barriers•Health education•provider/patient relationship and negotiating•Better protocols with fewer side effects•Cues to non-adherence

How does Medication Non-Adherence

compare to Drug Abuse?

Non-Adherence Drug Abuse

•Failing to take medications as prescribed

•Not seen as an ethical breach

•Poor health outcomes

•Financial costs to families and society

• Taking medications NOT prescribed

•Seen as an ethical breach

•Poor health outcomes

•Financial costs to family and society

Legal ConcernsIf it’s illegal to consume an illicit drug, should it also be illegal to FAIL to take a prescribed drug?

What about

Immunizations?

TB programs?

Forced quarantine?

Further Research is NeededTo bridge the gap between what it means to take a drug to feel good, versus taking a drug to be well.

Conclusion/Questions