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1. Patient Non-Compliance With Medications 3rd Year Research Project Class of 2007

2. Introduction • Medication non-compliance …..the world’s “other drug problem”4

3. Medication Non-Compliance • As dangerous and costly as many illnesses • Increases the cost of healthcare as a result of adverse outcomes4 (i.e. hospitalizations, development of additional illnesses/complications, exacerbation of the disease or disease progression, premature disability, or death)

4. Medication Non-Compliance • In the United States, 50-70% of patients do not properly take their medications5 • Costs of patient non-compliance are estimated at over $100 billion annually5

5. Definition Compliance, simply defined as “agreement.” With regard to medicine, compliance means agreeing to take medicine(s) as directed, and then following through with that agreement…..accepting the responsibility of taking medicine(s) as agreed8

6. Definition Adherence is defined as the extent to which a patient’s health behavior coincides with their physician’s recommendations, whether taking medications or following advice for some type of behavioral change

7. Adherence vs. Compliance • Adherence is a more accurate term than compliance • Compliance suggests a process in which dutiful patients passively follow the advice of their physicians • Adherence, in contrast, better fits how most patients actively participate in their care and decide for themselves when and whether to follow their doctor’s advice

8. Background Research • Multiple studies done looking at adherence to medication and recommended interventions to improve compliance • Typical adherence rates for prescribed medications are about 50% with a range from 0% to 100%1 • Adherence greater during first 6 months of follow up and drops thereafter1 • Chronic and asymptomatic disease have lower adherence rates than acute ones1

9. Recent Studies • Primary Medication Adherence in a Rural Population: The Role of the Patient-Physician Relationship and Satisfaction with Care (Thomas H. Wroth, MD, MPH and Donald E. Pathman, MD, MPH ) – Prescription primary non-adherence is prevalent in the rural South. Adherence may be improved by remedying patient dissatisfaction and lack of confidence in their physicians as well as addressing transportation barriers

10. Recent Studies • Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol – A pharmacy care program led to increasesin medication adherence, medication persistence, andclinically meaningful reductions in BP, whereasdiscontinuation of the program was associated withdecreased medication adherence and persistence

11. Background Research • Although correlates of overall medication adherence have been studied, little is known about primary medication non-adherence and whether it relates to how patients view their physician, satisfaction with their care, and how easy or difficult it is for them to travel for care

12. Hypothesis • Patient non-adherence with medications can be attributed to 4 key reasons: • Language Barrier • Low Education Level • Poor doctor-patient interaction • System related obstacles

13. Objectives • To evaluate if language barriers interfere with patient adherence with medications • To discover if low literacy has an impact on patient adherence • To assess if doctor-patient interaction has an effect on patient adherence • To find if there are system-based factors that interfere with patient adherence

14. Purpose Of Our Study To identify the factors that contribute to patient non-adherence with medications in an effort to optimize patient care and reduce morbidity and mortality

15. Methods • 3-page survey constructed with questions written at 8th grade level in both English and Spanish • Questionnaires written in Spanish were reviewed by certified interpreters to check for accuracy • Each Resident was assigned with the task of completing a minimum of 30 surveys

16. Methods • Questionnaires were given to “eligible” patients upon registration for a clinic visit • Some Residents surveyed their assigned patients once they entered the patient’s room • Eligibility determined by inclusion and exclusion criteria*

17. Inclusion Both genders All Ethnicities Age 18 years old Taking  1 prescription medication not under the exclusion criteria* Registered as FCC patient for > 1 year Last visit to FCC w/in 6 months *special inclusion for ASA for cardiovascular risk prevention and calcium with vitamin D for postmenopausal women not on HRT Exclusion Age < 18 years old Pts. with dementia or cognitive impairment requiring assistance or special needs FCC patient for < 1 yr. Last visit to FCC > 6 m. Any medication(s) not taken on a scheduled basis OTC meds NSAIDs Narcotics Inclusion/Exclusion Criteria

18. Methods • Patients allowed as much time as needed to complete surveys, and able to use medication bottles/lists for assistance • Physicians reviewed surveys upon completion to verify accuracy and make any necessary clarifications during patient interview • Questionnaires valid once signed by physician

19. Methods • Data compiled to see: • What percentage of patients know the medications they are taking and for what reason • What patients do when they run out of their medication • What reason(s) patients give for not taking their medication as prescribed

20. Methods • Data collected used to identify the specific individual-based obstacles as well as system-based obstacles involved in medication adherence

21. Methods • Identify problematic areas as defined by our patient population • Implement strategies in FCC to improve medication adherence and standard of care

22. Survey 1. Circle your gender: Female Male 2. Circle your ethnicity (optional) Caucasian Hispanic Africanamerican Asian Philipino American-Indian Other 3. Circle the language or languages that you speak: English Spanish English and Spanish other 4. How old are you? (Circle the one that apply) 18-30 31-45 46-65 65 or more

23. Survey 5. How long have you been a patient in Family Care Clinic? 1-3 years 3-6 years more than 6 years 6. What is your education level? (Circle the one that applies better to you) A. Don’t know how to read B. Can read with difficulty C. Can read very well D. Finish elementary school E. Finish High school F. More than high school

24. Survey 7. What kind of insurance do you have? MISP MEDICAL MEDICARE IEHP Exclusive Care MOLINA Self Paid Pending 8. Do you know the medications you are taking? Yes No 9. Do you have the mediations with you? Yes No 10. Can you name them? Yes No 11. Do you know what the medications you are taking are for? Yes No 12. How many medications are you taking? 13. How many times a day do you have take your medicines?

25. Survey 14. Where do you get your medications? RCRMC Other Pharmacy 15.What do you do when you run out of medication? (Circle what happens most often) A. Call the pharmacy B. Call the doctor’s office C. Call the special line to refill medications D. Go to the emergency room E. Stop taking the medication

26. Survey 16.What are the reason(s) that you run out of medication? (you can choose more than one) [If you choose more than one, please put* next to the most common reason] • A.     Pharmacy lost the prescription • B.     Language problem in communication with Pharmacy . If yes was an interpreter available Yes No • C.     Medications needs TAR form to be filled by the doctor • D.     Didn’t have the copayment to pay medications • E.      Pharmacy was closed when trying to get prescriptions • F.      Pharmacy was to slow and left without getting the prescriptions • G.     Didn’t have doctor’s license number in prescription when trying to get prescriptions outside the hospital • H.     Hard time getting transportation to pharmacy • I.        Finish medications earlier than the next doctor’s appointment • J.       Waiting for doctor’s office to refill medication

27. Survey 17. Did you know there is a special phone line to refill your prescriptions over the phone Yes No 18. If yes Have you ever use it? Yes No If yes, were you able to refill your medications through it? Yes No If Not, you couldn’t do it because: A. Didn’t understand how to use it? B. Line was too busy most of the time and couldn’t get through it C. Unable to spell the name of your medication D. Left message over the phone but didn’t get a call from the Dr. telling you that your prescriptions were ready.

28. Survey 19. Reasons why you don’t take your medications as prescribed: (Circle all the reasons that apply to you) • A. Forget to take it • B. Confusion as to what medication to take and when • C.  Fear of side effects • D. Don’t know what the medications you are taking are for • E. Feel depressed or sad and don’t feel like taking the medicines • F. Disorganization, lose medications can’t find where are they

29. Survey 20. What motivates you the most to take your medications? (Circle all that apply) Put * next to the main reason • A. The doctor during the visit • B. The nurses • C. Myself • D. My family • E.  Friends F.  Other 21. Please write down any suggestions to improve your own compliance with your medications

30. Answer Rate -TOTAL OF PATIENTS INTERVIEWED→ 296 -NOT ALL PATIENTS ANSWERED ALL THE QUESTIONS -OF 21 QUESTIONS 13 (62%), WERE ANSWERED BY MORE THAN 290 PATIENTS -6 (23%) QUESTIONS WERE ANSWERED FOR AT LEAST MORE THAN 250 PATIENTS, MOST OF THESE QUESTIONS WERE REGARDING KNOWLEDGE OF MEDICATIONS BEING TAKEN

47. Of the 84 that couldn’t refill, 5 didn’t understand how to use it

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