A significant challenge in healthcare efficacy is the adherence to treatment plans, medications and therapeutic techniques by patients in overall outcome. Adherence to medicines of certain classes i.e. antibiotics, blood pressure modulators and diabetic treatments is particularly troublesome and poses barriers in effective treatment to healthcare providers and pharmacists alike. The concept of adherence in patient outcome is multi-faceted and often not diagnosable on one or two factors, but is a combination of socio-economic, personality and technology-based barriers. Technological advancements in medicine are without merit if the adoption and adherence to therapeutic regimens is not upheld, leading treatments essentially redundant.
The effective implementation of medication based on adherence can be summarized as;
Barriers to any of the above pose limitations to the overall efficacy of a treatment, yet other factors influence the decision to neglect the proper self-administration of medicines.
Lack of patient knowledge around the treatment
Patients acquiring their prescription at a community pharmacy upon discharge from hospital or after a doctor consultation should be promptly interviewed by the head pharmacist to ascertain their current knowledge over the prescribed treatment. Proper information as to the mechanism of action, side effects and benefits of the treatment to their specific condition will aid in reinforcing patient motivation to continue their treatment in the prescribed manner. Furthermore, pharmacists should seek to discourage anecdotal evidence for or against treatment i.e. “my friend took this instead, this didn’t work for her” to reinforce evidence-based recommendations for therapeutic treatment of conditions. Pharmacists should seek to explain to patients that not all treatments provide benefits which can be tangibly felt (unlike painkillers, anti-inflammatories and creams), but inform the patient that often these benefits are subtle and can provide essential protection against co-morbidities (such as blood pressure modulators, warfarin and statins – the immediate cessation of which poses serious health risks).
Specific limitations of therapy
Certain therapies pose side effects, risks and unpleasant experiences for a patient, often in necessity to treat a potentially more dangerous condition. Patients who have a history of non-adherence or disbelief in medical diagnoses may be somewhat more reluctant to undertake and maintain treatment regimes, and special care should be made to consult with these patients. Upon encountering side effects, the pharmacist should seek to ease the concerns the patient has whilst giving advice on the administration of the drug (before or after meals), certain lifestyle factors to avoid during treatment (avoiding alcohol or discontinuing herbal treatments) and any other medications which can be used synergistically to decrease the incidence of side effects (i.e. use of a proton pump inhibitor in treatment using potent anti-inflammatory drugs).
Finally, a reminder of the World Health Organisation’s factors affecting medicine adherence;