Inappropriate adherence to treatment regimes is a substantial impediment to achieving better response for patients. Not adhering to drugs affects the length and quality of life and can be associated with unwanted health outcomes and uncontrollable health care costs. The condition is even worse for elderly patients who are likely to be affected by chronic diseases, therefore, receiving multiple treatments. No single strategy has been effective in enhancing adherence in all patients, conditions, and situations. Adherence does not appear to be a priority area for medical personnel especially pharmacist a situation that is worsened by lack of reimbursement for initiatives aimed at accession. Similarly, time and monetary compensation are additional barriers that inhibit family physicians from collaborating with community pharmacist to enhance patient adherence. Despite the reluctance by healthcare providers to promote adhesion, it is necessary to understand that this is a complex problem that is patient specific and often multi factorial. The situation is even worsened by the elderly who have other issues that compound the matter. No single intervention has proved to be effective in improving adherence. Any response that has enhanced adherence, improved overall health and to some extent reduced health care cost have employed a combination of approaches that are customized to the needs of the patient (Marengoni et al. 2016).
Objective
To formulate a strategy that will reduce the level of non-adherence to a drug regime by elders
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Target group
Adults over sixty-five years who are hesitant to initiate a therapy or have skipped doses, or have discontinued medication or those who have self-adjusted the dose or those who have over adherence
Problem
In some situation, a patient does not take the prescribed drug. They usually offer different reasons for their hesitance to initiate therapy including forgetfulness, feeling better than before, being scared of the side effects, not understanding the pharmacist, advice from other people including family and caregivers, natural forces and not trusting the medication. In other situations, the .patients skipped the medication either because they were not at home or they forgot. Patients who are on medication can also decide to discontinue. The elders take such actions either because they feel that it is not working or they are feeling well or assume to be cured. Where the prescribed drug is expensive, some of the patients can opt to change their dose to save money. They might decide to use generic drugs or adjust the dose to suit their budgetary constraints. Some of the patients might be experiencing extreme pain and therefore to alleviate the situation, they opt to over adhere to counter the pain or to manage increasing symptoms. They take more drugs than the prescribed dosage by the pharmacist. Lastly, some of the elderly patients misuse the drugs by either not following the prescription or using the drug for other purposes known only to them.
Adherence factors
The above problems are linked to the following factors which are related to non-adherence by the elderly. The factors apply to all elders above the age of sixty-five years. They include; fear and incidence of adverse effects, health as a low priority, the complexity of the regimen, social isolation, high number of medication, the presence of cognitive defects, long treatment durations, disagreements or denial belief that medication is not working, communication breakdown, psychological problems frequency of health care visits (Marengoni et al. 2016; Worth; 2010).
Approaches
The following initiatives are applicable in designing the strategy. Conducting a comprehensive geriatric assessment and empowering the patient and the caregiver through education. Additionally, the physician and the healthcare professionals are to be educated on how to improve drug adherence. It will also optimize treatment and use adherence aids. Carry out adherence assessment and facilitate access to medication by integrating services. For these interventions to yield the desired results, they should be targeted to the elderly and incorporate healthcare professionals. Similarly, it will consider the instruments or strategies needed for the implementation and the required time for the intervention Marengoni et al. 2016; Worth; 2010).
Adherence strategy (Medication taking and reminder system)
A comprehensive plan that addresses the above problem considering the identified factors will solve the non-adherence by elderly patients. Start by developing a trusting relationship between the patient and the provider. Simplify the treatment as much as possible. This strategy will help the elderly adhere to the prescribed drugs and will be essential to all healthcare service providers. For each identified problem, different approaches are combined according to the complex aspects of the patient. For improved drug adherence, a multi stake-holder patient centered approach that is operating within a defined framework of interaction with different integrated stakeholders offering unique services will help improve adherence or reduce non-adherence. This strategy should; recognize all medical conditions that are prevalent among the elderly population, identify any side effects from use of certain drugs including those that are likely to cause or aggravate risks related to certain medical conditions. Assess the ability of a patient to stick to a regimen including any noticeable impairment. The patient should be educated on how to use different delivery systems like inhalers and transdermal patches. The medication labels should be printed and must be in a language that can be understood by the patient. Any complexity and duplication in the drug regimen should be eliminated. The patients should be advised on healthy living practices and prevention of diseases. The patients can also be taught how to use medication adherence tools like drug calendar reminders, electronic drug dispensing devices, labeled pillboxes and drug boxes and pill splitters or crushers. Consumers should be included in planning and decision making on health services including the research process. The strategy developed will be a medication taking and reminder system (Lee, 2013; Marengoni et al. 2016; Worth; 2010).
References
Lee, V. K. (2013). Formulating medication adherence strategies using the PASSAction framework. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada,146 (1), 30-32. doi:10.1177/1715163512472320
Marengoni, A., Monaco, A., Costa, E., Cherubini, A., Prados-Torres, A., Muth, C., . . . Onder, G. (2016). Strategies to Improve Medication Adherence in Older Persons: Consensus Statement from the Senior Italia Federanziani Advisory Board. Drugs & Aging, 33 (9), 629-637. doi:10.1007/s40266-016-0387-9
Worth, T. (2010). Medication Adherence Strategies: We Can Do Better. AJN, American Journal of Nursing, 110 (4), 15. doi:10.1097/01.naj.0000370144.18869.0
