Complications Of Medication Non-Adherence
Medication Non-Adherence
The term non-adherence can often be mistaken and used interchangeably with the term non-compliance. Throughout this paper, we will use the term medication adherence, meaning the act of taking the prescription to a pharmacy, filling the order and being compliant with taking the medication as prescribed, on time. Medication non-adherence has been a serious problem for providers who treat patients with psychiatric illnesses such as schizophrenia and bipolar disorder. “Non-adherence rates in patients with schizophrenia, bipolar disorder, and depression are often greater that 50%” (Pharmacy Today, 2013). A suggestive reason as to why individuals with schizophrenia and bipolar disorder disregard taking their medication is due to their lack of perception to the severity of their illness. “Anosognosia (a=without, noso=disease, gnosia=knowledge) is the term used to describe the neurologically-based denial of illness and unawareness of disability and is the single most significant reason why individuals with severe psychiatric disorders often do not take their medication” (Lehrer, Lorenz, 2014). Patients will often forget or deny that they have a large medication regimen when they are cognitively unaware of their illness.
Crucial complications can arise in a patient’s care plan when psychiatric medications such as antipsychotics, antidepressants, anticonvulsants, minor tranquilizers, b-blockers, antiparkinsonian agents, or mood stabilizers such a lithium, are not taken as scheduled. These drugs are utilized for a variety of acute inpatient indications including the treatment and prevention of delirium, agitation, and insomnia. “Poor medication adherence has a substantial impact on disease progression, and can put individuals at risk for homelessness, incarceration in jail or prison, victimization, or episodes of violence” (Pharmacy Today, 2013). Ultimately, for individuals that are using these medications to improve quality of life, non-adherence can have the opposite effect as well as decrease life expectancy.
In patients with psychiatric illnesses taking antipsychotic medications, is collaboration with clients, family members, and interdisciplinary healthcare, through proper communication and education, more effective in increasing patient medication adherence when compared to standard patient discharge education alone without collaboration?
Synopsis of problem
“An estimated 15, 272 annual emergency department visits are attributed to adverse drug events related to atypical antipsychotic use” (Fontaine, Mortensen, Guinto, Scott, Miller, 2018). Helping patients take their medication appropriately would prevent unnecessary admissions to emergency departments and hospitals every day, at the cost of billions of dollars a year. “The cost of rehospitalizations has been estimated to be $100 billion per year, with non-adherence costing $290 billion annually” (Pharmacy Today, 2013). This issue not only affects hospitalizations but the public as a whole.
Another main reason for poor effective use of medications is poor provider to patient communication and inadequate knowledge about the drug. Due to the increasing prescriptions that physicians are writing up for patients on their way out of medical facilities, studies are performed and in a 2014 study “researchers asked the prescribing physicians how they had intended for the patient to take the drug and asked the patients how they were actually taking them. Interpretations of the prescription showed discrepancies for 44 of the 115 (38%) prescription instructions” (Harris, Bradshaw, Koch, Whyte, 2014). The study not only found discrepancies from physician to patient, but physician to pharmacist to patient education, as well as nurse to patient education discrepancies. Figure 1. Conceptualization of the information flow of prescription instructions and the resulting multiple opportunities for misinterpretation ISSN 1925-4040 E-ISSN 1925-4059
Communication and proper education are central to optimizing patient adherence. When teaching patient education, it is crucial that nurses provide exceptional patient education at hospital discharge and receive proper feedback so that nurses understand that the teaching was successful, and that patients have grasped drug information and dosing pattern, which will then in turn decrease their chances of relapse. “Nurses can play a vital role in improving medication adherence by collaborating with clients to identify obstacles and working with clients, family members, and other healthcare providers to then identify effective strategies to enhance medication adherence” (Mahone, Maphis, Snow, 2016). As educators and advisers, nurse managers need to be able to help their nursing staff with any patient education they may need assistance with and helping to collaborate for the best patient outcome at discharge of each patient with psychiatric needs. During transitions in care, not only is the nurse role in a patient’s care important, but also the pharmacist’s role on a patient's medication-related problem. The pharmacist education to the family members and patient is instrumental in improving his/her quality of life. When a team of caring and committed healthcare staff can have effective communication on a patient’s plan of care after hospital discharge, the patient has an easier transition to medication adherence and optimal patient satisfaction.
Review of the Literature
Harris, Bradshaw, Koch, and Whyte (2014) in a level one (1) study of observational cross-sectional study design, performed their interviews in a large university setting as well as 2 hospitals and various clinics in 2 different states. They interviewed a group of 74 healthcare consumers, 34 RNs, and 36 physicians total. The article found that in asking people for interpretations for various prescription instructions (i. e. what time would you/should you take the drug), there was no uniformity in interpretations between physicians, nurses, and healthcare consumers. A fair number of nurse and consumer interpretations resulted in unsafe schedules of drug administration. Physicians and nurses also lacked awareness of the possibility of such variations of interpretations of drug labels. This study was an eye-opener to healthcare workers as to the kind of education they are providing to their drug consumers within one group/unit alone. Medication adherence depends heavily on the interpretation of dosage instructions from healthcare professionals. A small variability in drug interpretation can cause life-threatening consequences for any consumer.
Mahone, Maphis, and Snow (2016) is a level one (1) systematic review of evidence-based clinical practice for clients with schizophrenia and medication treatment to maintain symptom control. This article models different strategies nurses can employ in collaboration with patients to improve medication adherence. In the past, traditional medical models did not allow for much patient engagement in self-care. The article also explains that research has shown the idea of patient independence through job employment to help reduce family stress levels which also, in turn, helps with medication adherence. This article focuses on the need for shared decision-making tactics for psychiatric nursing care to include healthcare staff and the patient to aid in recovery towards health and wellness.
Wolf, Davis, Curtis, Bailey, Knox, Bergeron, Abbet, Shrank, Parker, and Wood (2016), a level two (2) two-arm, multi-site, patient-randomized pragmatic trials were performed to show how a patient-centered prescription drug labeling (PCL) strategy could improve proper use and medication adherence compared to a regular standard drug label. Fig. 2 Sample of patient-centered label (PCL) versus a standard drug label. A simple 1: 1 randomization scheme was used to assign 845 random patients to either the PCL or standard care label. Medication adherence was calculated at the three-month mark and at the end of the nine-month study. Through calculations using chi-square tests, generalized linear models (GLM) and generalized estimating equation (GEE), results showed more patients demonstrated correct use in the PCL arm than the standard care arm (85. 9 % vs. 77. 4 %, p = 0. 03). Although, there was a slight increase in correct use of the new label, it is believed that the PCL and standard label may still represent a potential practice standard with further study.
