what must occur prior to initiating an effective therapeutic regimen? (select all that apply.)
Mayo Clin Proc. 2011 Apr; 86(iv): 304–314.
Medication Adherence: WHO Cares?
Abstract
The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although these medications are effective in combating disease, their full benefits are often non realized considering approximately 50% of patients practice non take their medications as prescribed. Factors contributing to poor medication adherence are myriad and include those that are related to patients (eg, suboptimal wellness literacy and lack of involvement in the treatment decision–making process), those that are related to physicians (eg, prescription of complex drug regimens, communication barriers, ineffective communication of information about agin effects, and provision of care by multiple physicians), and those that are related to health care systems (eg, office visit time limitations, express admission to care, and lack of wellness it). Considering barriers to medication adherence are complex and varied, solutions to improve adherence must exist multifactorial. To assess general aspects of medication adherence using cardiovascular affliction as an example, a MEDLINE-based literature search (January 1, 1990, through March 31, 2010) was conducted using the post-obit search terms: cardiovascular illness, wellness literacy, medication adherence, and pharmacotherapy. Transmission sorting of the 405 retrieved articles to exclude those that did not address cardiovascular disease, medication adherence, or wellness literacy in the abstract yielded 127 manufactures for review. Additional references were obtained from citations within the retrieved articles. This review surveys the findings of the identified articles and presents diverse strategies and resources for improving medication adherence.
Keep a watch…on the faults of the patients, which frequently make them lie about the taking of things prescribed. For through not taking disagreeable drinks, purgative or other, they sometimes dice.
Hippocrates, Decorum
In its 2003 report on medication adherence,one the World Wellness Organization (WHO) quoted the argument by Haynes et al that "increasing the effectiveness of adherence interventions may take a far greater impact on the health of the population than any comeback in specific medical treatments." Among patients with chronic affliction, approximately l% practise non take medications every bit prescribed.1,2 This poor adherence to medication leads to increased morbidity and death and is estimated to incur costs of approximately $100 billion per year.iii Thus, Hippocrates' exhortation to the doc to "non just be prepared to do what is right himself, but also to make the patient…cooperate"4 has consistently failed for more than 2000 years. Today's ever more complicated medical regimens make information technology fifty-fifty less likely that physicians will be able to compel compliance and more important that they partner with patients in doing what is right together.
This review volition discuss general aspects of medication adherence, using cardiovascular disease (CVD) every bit an instance, and provide the dr. with various applied strategies and resources for improving medication adherence among their patients.
METHODS
We conducted a MEDLINE database literature search limited to English- and non–English language-linguistic communication articles published between January 1, 1990, and March 31, 2010, using the following search terms: cardiovascular illness, health literacy, medication adherence, and pharmacotherapy. Of the 405 articles retrieved, those that did not address CVD, medication adherence, or health literacy in the abstract were excluded, leaving 127 for inclusion in the review. Additional references were obtained from citations inside the retrieved articles.
For editorial comment, see folio 268
General ASPECTS OF MEDICATION ADHERENCE
Medication-taking behavior is extremely complex and private, requiring numerous multifactorial strategies to improve adherence. An enormous amount of inquiry has resulted in the evolution of medications with proven efficacy and positive benefit-to-chance profiles. This millennium has seen a new and greater focus on outcomes. Withal, we seem to have forgotten that between the quondam and the latter lies medication adherence:
Treatment → Adherence → Outcomes
The WHO defines adherence to long-term therapy as "the extent to which a person's beliefs—taking medication, following a diet, and/or executing lifestyle changes—corresponds
with agreed recommendations from a health intendance provider."1 Often, the terms adherence and compliance are used interchangeably. However, their connotations are somewhat different: adherence presumes the patient's agreement with the recommendations, whereas compliance implies patient passivity. As described by Steiner and Hostage,5 both terms are problematic in describing medication-taking beliefs considering they "exaggerate the md's control over the procedure of taking medications." The complex issues surrounding the taking of medication for chronic disease cannot easily exist distilled into ane word. Recognition of this complexity will help avert assigning blame exclusively to the patient and assist in identifying constructive solutions.
Measurement of medication adherence is challenging because adherence is an individual patient behavior. The following are some of the approaches that have been used: (1) subjective measurements obtained by asking patients, family unit members, caregivers, and physicians about the patient'due south medication use; (ii) objective measurements obtained past counting pills, examining pharmacy refill records, or using electronic medication event monitoring systems; and (iii) biochemical measurements obtained by adding a nontoxic mark to the medication and detecting its presence in claret or urine or measurement of serum drug levels. Currently, a combination of these measures is used to assess adherence behavior. Along with the monitoring of event, these tools assist investigators in studying medication adherence.
Patients are more often than not considered adherent to their medication if their medication adherence percentage, divers as the number of pills absent in a given time period ("X") divided past the number of pills prescribed by the md in that same fourth dimension period, is greater than 80%3,vi:
One limitation to calculating adherence using this method is that it assumes that the number of pills absent were actually taken by the patients. In addition, this method may non exist representative of long-term adherence patterns because patients may exhibit white-coat adherence, or improved medication-taking behavior in the v days before and 5 days after a health intendance encounter.iii
INCIDENCE OF NONADHERENCE
According to a 2003 report published by the WHO, adherence rates in developed countries boilerplate only about l%.1 Adherence is a cardinal factor associated with the effectiveness of all pharmacological therapies but is specially disquisitional for medications prescribed for chronic conditions. Of all medication-related hospitalizations that occur in the Us, between one-3rd and two-thirds are the result of poor medication adherence.3 A fair amount of data is bachelor regarding medication adherence in CVD considering, for many of the risk factors, adherence can be roughly approximated via the measurement of surrogate markers. For example, adherence to antihypertensive therapy tin be approximated by measuring blood pressure (BP) control, and adherence to lipid-lowering therapy can be approximated by measuring lipid levels. Considering about research is disease-specific and not focused on medication adherence alone, this review volition focus on medication adherence as it relates to CVD. Examining adherence in patients with CVD is a useful model for helping physicians sympathise medication adherence in other chronic atmospheric condition.
Cardiovascular complications resulting from hypertension, hyperlipidemia, and diabetes lead to substantial disability, morbidity, and mortality. For example, for every increase of 20 mm Hg in systolic BP and every increase of 10 mm Hg in diastolic BP, the chance of stroke and ischemic heart disease doubles.seven Because of this increased risk, comprehensive treatment plans for patients with established CVD include antidiabetes, antihypertensive, and lipid-lowering (typically statin-based) therapies for patients who nowadays with diabetes, hypertension, and dyslipidemia, respectively.8
Although it is well known that antidiabetes, antihypertensive, and lipid-lowering therapies significantly reduce the hazard of ischemic events,ix-11 long-term adherence to these medications is poor even amongst patients who have already experienced a cardiovascular event (Figure ane).12 For instance, despite the fact that pharmacological antihypertensive therapy has a positive safety and tolerability contour and reduces the gamble of stroke by approximately xxx% and myocardial infarction (MI) by approximately 15%,xi testify from a number of studies suggests that equally many as fifty% to 80% of patients treated for hypertension are nonadherent to their treatment regimen.13-fifteen According to the WHO, this lack of adherence is the most of import crusade of failure to achieve BP command.one Failure to reach BP control significantly increases the risk of MI, stroke, and hospitalization.xvi,17 As expected, adherence to antihypertensive therapy reduces the run a risk of these events.eighteen
Persistence with secondary prevention medication in the 24 months subsequently ischemic stroke in Sweden. Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke.
From Stroke,12 with permission.
Comprehensive treatment plans for patients with CVD as well include indefinite use of antiplatelet therapy.8 For patients with middle disease, ischemic cerebrovascular illness, or peripheral artery disease, aspirin or clopidogrel monotherapy has a favorable benefit-to-risk profile; for patients who experience an ischemic cerebrovascular event, therapy with aspirin plus extended-release dipyridamole is an additional treatment option.xix For patients who experience acute coronary syndrome or undergo percutaneous coronary intervention with stent implantation, dual antiplatelet therapy with aspirin and either clopidogrel or prasugrel is recommended for at least 12 months for those not at a high risk of bleeding.20
Like adherence to antihypertensive therapy, adherence to statins and antiplatelet agents is poor, every bit are the outcomes associated with nonadherence. Within 6 months to 1 year after having been prescribed statins, approximately 25% to l% of patients discontinue them21-24; at the end of two years, nonadherence is as high as 75%.25,26 Achievement of the treatment goals recommended by the National Cholesterol Educational activity Programme is also poor.27,28 With regard to antiplatelet therapy, studies that assessed long-term aspirin employ constitute that rates of adherence across 1 year ranged from 71% to 84%.29-32 For dual antiplatelet therapy recipients, premature discontinuation of clopidogrel rates has been reported to occur in 12% to 14% of patients within 1 to iii months of initiation33,34 and in up to 20% of patients beyond six months.35,36
Nonadherence to lipid-lowering and antiplatelet therapies is associated with an increased risk of adverse cardiovascular outcomes.16,32,34,36-41 Aside from the increased risk of MI, stroke, and death, stent recipients who prematurely discontinue clopidogrel likewise have an increased rate of stent thrombosis.34,36,42-45 For example, in an assay of 3021 drug-eluting stent recipients, discontinuation of clopidogrel within 6 months of stent implantation was the strongest predictor of 6-month stent thrombosis (hazard ratio, 13.74; 95% confidence interval, four.04-46.68; P<.001).43 In a written report of 500 drug-eluting stent recipients, thirteen.half-dozen% of patients discontinued thienopyridine therapy within 30 days.34 These patients had a ten-fold greater bloodshed charge per unit at 1 year than those who continued thienopyridine therapy (vii.v% vs 0.7%).34
CAUSES OF POOR MEDICATION ADHERENCE
Poor adherence to medical treatment severely compromises patient outcomes and increases patient mortality. Co-ordinate to the WHO, improving adherence to medical therapy for conditions of hypertension, hyperlipidemia, and diabetes would yield very substantial health and economic benefits.one To improve medication adherence, the multifactorial causes of decreased adherence must be understood. The WHO classifies these factors into 5 categories: socioeconomic factors, factors associated with the wellness intendance team and system in identify, illness-related factors, therapy-related factors, and patient-related factors.one In broader terms, these factors fall into the categories of patient-related factors, physician-related factors, and health arrangement/squad edifice–related factors.
Patient-Related Factors
Several patient-related factors, including lack of understanding of their disease,46 lack of interest in the treatment determination–making procedure,47 and suboptimal medical literacy,48 contribute to medication nonadherence. In the Usa alone, an estimated ninety million adults have inadequate health literacy,49 placing them at risk for increased rates of hospitalization and poorer clinical outcomes.fifty,51 The patient'due south health behavior and attitudes concerning the effectiveness of the handling, their previous experiences with pharmacological therapies, and lack of motivation also affect the degree of medication adherence.3,52,53 Medication adherence continues to decline even after a catastrophic event such as a stroke (Figure 1)12; thus, information technology is not surprising that treating asymptomatic conditions to foreclose the possible occurrence of agin events years subsequently presents an even greater challenge. Specific factors identified equally barriers to medication adherence amongst inner city patients with low socioeconomic status were high medication costs, lack of transportation, poor understanding of medication instructions, and long expect times at the chemist's.55 A lack of family or social support is also predictive of nonadherence,52,56,57 as is poor mental health.three,53,58 These findings are clinically relevant for patients with CVD because studies have shown that depression and anxiety are common in patients with coronary artery disease or stroke.59-61 Indeed, the poorer outcomes experienced by patients with depression and CVD may be due, at least in part, to poorer medication adherence past depressed patients.62,63
Physician-Related Factors
Not just do physicians oftentimes fail to recognize medication nonadherence in their patients, they may too contribute to information technology by prescribing circuitous drug regimens, failing to explain the benefits and adverse effects of a medication finer, and inadequately considering the financial burden to the patient.3,55 Ineffective communication between the primary intendance doc and the patient with a chronic disease such equally CVD farther compromises the patient's understanding of his or her affliction, its potential complications, and the importance of medication adherence.v Failing to arm-twist a history of culling, herbal, or supplemental therapies from patients is another source of ineffective communication.
Advice amidst physicians is frequently insufficient and may contribute to medication nonadherence. Direct advice between hospitalists and primary care physicians occurs in less than twenty% of hospitalizations, and belch summaries are bachelor at less than 34% of first postdischarge visits.64 Inadequate advice between physicians, hospitalists, master care physicians, and consultants likewise contributes to medication errors and potentially avoidable hospital readmissions.64,65
Health System/Squad Building–Related Factors
Fragmented health care systems create barriers to medication adherence past limiting the health intendance coordination and the patient's access to intendance.66 Prohibitive drug costs or copayments also contribute to poor medication adherence.35,67 Health information technology is not widely available, preventing physicians from easily accessing data from unlike patient intendance–related venues, which in turn compromises patient care, timely medication refills, and patient-physician communication. In an overtaxed wellness care organisation in which clinicians run across a large book of patients without resources to meet individual patient needs, the amount of time a clinician spends with patients may exist insufficient to properly appraise and sympathise their medication-taking behaviors. This lack of time may preclude engaging the patient in a discussion on the importance of medication adherence and strategies to accomplish success.
STRATEGIES TO Better MEDICATION ADHERENCE
Between 2000 and 2002, the typical Medicare casher saw a median of 7 physicians per twelvemonth: 2 chief care physicians and 5 specialists.68 This finding highlights the demand for coordinated, multifactorial strategies to improve medication adherence. Notwithstanding, given the enormous complexities involved in medication adherence, inquiry on improving adherence has been challenging and generally focused on single disease states. A recent Cochrane review of 78 randomized trials found no one simple intervention and relatively few complex ones to exist constructive at improving long-term medication adherence and wellness outcomes,69 underscoring the difficulty of improving medication adherence.
Although improving medication adherence is challenging, clinicians can accept several steps to assist patients' medication-taking behavior, and afterwards, outcomes. The ensuing discussion will focus on strategies to meliorate medication adherence related to the areas of patient-, physician-, and health system/team edifice–related factors. A summary of available resources that can exist used to implement these strategies is constitute in Table 1.
Tabular array 1.
Strategies and No-Cost Resources Aimed at Overcoming Barriers to Medication Adherence
Patient-Related Factors
Medication adherence is primarily in the domain of the patient.ane Considering patients remember as picayune as 50% of what is discussed during the typical medical meet,seventy effective patient instruction must exist multifactorial, individualized, and delivered in a variety of methods and settings outside of the examining room. A fundamental component of any adherence-improving plan is patient teaching. In i recent prospective written report of 1341 patients with hypertension, education of both the patient and physician was associated with improved BP control vs education of the md lonely.71 Formal health education programs, such as diabetes cocky-management education, have been shown to be effective72; nonetheless, access to similar non–disease-specific programs is express. In the absence of a formal program, physicians would do well to emphasize the availability of other educational resources, including but non limited to pharmacists, community health programs, and interactive Web-based materials such as those plant at www.medlineplus.gov (Table ane). It might also be beneficial to recommend to patients that they engage local librarians to help them admission the Net.
The more empowered patients feel, the more likely they are to be motivated to manage their affliction and adhere to their medications. Thus, another fundamental factor that tin can improve patient-related medication adherence is actively involving patients in treatment decisions when possible. 1 unproblematic way to involve patients is to inquire what time of mean solar day they would prefer to take their medications. Ane patient may be more than likely to adhere to his or her medications if they were taken in the evening, whereas for another, the forenoon may be preferred. Only the patient can brand this decision. Ascertaining how quickly patients would like to reach the desired medical upshot besides engages the patients in their care. For patients with CVD, this would include how quickly they would like to attain controlled BP and lipid levels. Patients' reply to this question tin can help the medico determine how quickly medication may need to be titrated and how often patients will need to be seen in the office or undergo laboratory testing. If a number of culling treatment options are recommended, offering patients choices encourages active participation in their treatment. For example, once adherence to one medication or treatment is realized and a sense of accomplishment attained, moving to the next recommendation and handling goal is more than achievable. Similarly, the dr. should avert prescribing numerous medications and behavioral modifications at any one visit because this may overwhelm the patient and induce a sense of futility. If it is necessary to prescribe more than than one drug or intervention during a given visit, a rationale should be provided for which are most of import because it will help ensure that, if patients decide to stop taking their medications for whatsoever reason, they will discontinue the most important medications last. It is also hoped that providing a rationale would encourage patients to inform their physicians of whatsoever plans to change medications, allowing for discussion.
Inadequate health literacy is often underrecognized and therefore not addressed by physicians.73 According to data from the beginning National Cess of Adult Literacy, conducted in 2003, 77 million U.s.a. adults (35%) have basic or below bones health literacy, whereas only 26.iv one thousand thousand (12%) accept good health literacy.74 Many patients with basic or below basic health literacy may be unable to read a medicine bottle or poison alert.75 In another study, almost one-half of patients with depression literacy admitted shame, which prevented them from seeking needed help.76 Of patients who admitted having reading bug and being ashamed, more than 85% hid their limited literacy from co-workers or supervisors, and approximately l% hid it from their children.76 The economic consequences of low health literacy skills are exemplified in a 1992 study conducted by the Academy of Arizona that showed that total annual health intendance costs for patients enrolled in Medicare with low health literacy were iv times greater than costs for patients with high health literacy.75 Comments such as "I'll read this when I get dwelling house" or "I forgot my glasses, can you read this to me?" are clues that the patient may have poor literacy. Uncomplicated tools to help the clinician are presented in Tabular array 1.
To help combat poor health literacy and its negative effect on medication adherence, a "shame-free" surround must exist created. Possible solutions to poor patient literacy include providing the patient with pictorial and audiovisual educational material instead of written instructions. Given that less than lx% of the Us population has English as their starting time language,75 providing data in the patient's native linguistic communication may as well lessen the burden of poor health literacy. For case, the Web site world wide web.medlineplus.gov provides simple audiovisual education in more than forty languages and 250 topics. The topics available in multiple languages include several related to CVD, such as cholesterol, coronary avenue disease, diabetes, heart attack, hypertension, peripheral artery illness, and stroke.
Recognizing and treating mental illness must be a priority when treating patients for other chronic weather such equally CVD. Often, successful treatment of patients' coexisting illnesses depends on commencement treating any underlying mental illness.
Consideration of patients' economical status is of paramount importance. Recognizing that patients' economic constraints volition limit their power to adhere to their medication, the doctor may straight patients to programs that provide financial aid. Such programs include pharmaceutical company–based assistance plans, state-based help plans, and pharmacies that provide 30-day supplies of widely prescribed medications, including many of those often prescribed for patients with CVD, for less than $5 (Table 1). A hospital social worker, practice champion, or community center volunteer may offer the time and resource necessary to assist individual patients.
Physician-Related Factors
The substantially improved adherence of patients who written report a practiced relationship with their medico highlights the important part of physicians in the medication adherence equation.3 Similar to any human relationship, ane cardinal to a expert physician-patient human relationship is effective advice. Thus, perhaps the foremost strategy physicians tin can use to increase medication adherence is to follow a patient-centered approach to care that promotes active patient involvement in the medical decision–making process. As part of such a patient-centered approach, the doctor should consider patients' cultural beliefs and attitudes. For example, a mutual cultural mental attitude held past many patients is a preference for herbal remedies. Reassuring such a patient with diabetes that metformin is derived from the French lilac might improve his or her acceptance of the therapy.
A recent article by Attain54 addressed the behavior of people who accept a "gustation for the present rather than the future" and proposed that these "impatient patients" are unlikely to adhere to medications that require long-term utilise. In it, he proposes that, if an "impatience genotype" exists, assessing these patients' view of the hereafter while stressing immediate advantages of adherence may improve adherence rates more than emphasizing potentially distant complications. Reach54 suggests that rather than attempt to change the character of those who are "impatient," it may exist wise to ascertain the patient's individual priorities, particularly every bit they chronicle to firsthand vs long-term gains. For example, while advising an "impatient" patient with diabetes, stressing improvement in visual acuity rather than avoidance of retinopathy may result in greater medication adherence rates. Additionally, linking the cost of frequently changing prescription lenses because visual acuity fluctuates with glycemic levels may provide insight to the patient and an immediate financial motivation for improving adherence.
Overall, by acknowledging the presence of cultural beliefs and attitudes, physicians can build trust with their patients and proactively address whatever culture- or belief-related adherence barriers.77 An essential component of effective physician-patient relationships is the creation of an encouraging, "blame-free" surround, in which patients are praised for achieving treatment goals and are given "permission" to honestly answer whatsoever questions related to their treatment.
Past asking the appropriate questions, physicians tin accurately assess which medications patients are taking and how they are taking them. At a routine visit, patients may be asked twice to list their medications (eg, on a form while waiting to be seen and again when the nurse escorts them to the exam room). Notwithstanding, but listing medications does not address whether they are actually being taken. Thus, if the doctor assumes that the medications listed are existence taken, the scene for miscommunication is set. Assessment of medication-taking patterns may exist more efficiently obtained past request a number of direct questions in a nonjudgmental style (Tabular array two).
TABLE 2.
Questions a Clinician Can Enquire to Assess a Patient's Medication Adherence
Inquiring whether patients plan on "rationing" or "sharing" their medication for financial or other reasons is essential because this is a common do frequently kept from physicians. If physicians are aware that patients plan to ration their medication, they will exist able to discuss the importance of taking the medication as directed or to prescribe a different medication that is more than "forgiving." Forgiving drugs are defined every bit those for which a missed dose is less detrimental to long-term outcomes.78 Alternatively, physicians might prescribe a drug taken on a monthly basis or administered past depot or transdermally.
Physicians have several opportunities to amend medication adherence when prescribing drugs. Prescribing the maximum number of doses possible at once, thereby limiting the frequency of chemist's shop visits, and acknowledging the patient's economic status by adhering to their formulary improve adherence past minimizing economical barriers. An increased number of pills ingested per day may also decrease adherence.29,79-81 A recent study past Benner et al81 of approximately 6000 patients enrolled in a managed care setting focused on the effect of previous prescription burden on future adherence rates when antihypertensive or lipid-lowering therapy were added. Adherence rates decreased to 41%, 35%, and 30% in patients who received 0, 1, and 2 previous medications, respectively; among patients with x or more previous medications, adherence was twenty% (Effigy 2). Information technology is interesting to note that adherence rates were increased by initiating antihypertensive and lipid-lowering therapies concurrently. To help combat the decreased adherence associated with polypharmacy, physicians should consider prescribing fixed-dose combination pills when possible. Indeed, information suggest that adherence to multidrug antihypertensive and lipid-lowering therapy regimens is improved when single- vs multiple-pill regimens are used.82-84 For example, a meta-analysis of fixed-dose vs free-drug regimens in more than 20,000 patients identified a 26% decrease in the take a chance of nonadherence associated with a fixed-dose combination.82
Percentage of patients adherent (proportion of days covered ≥80%) to antihypertensive (AH) and lipid-lowering (LL) therapy, by prescription burden.
From Am J Wellness Syst Pharm,81 with permission. ©2009, American Society of Wellness System Pharmacists, Inc. All rights reserved.
Medications with once-daily dosing may be preferable to medications with multiple doses per day because minimizing the frequency of dosing has been shown to meliorate adherence.85 In a meta-analysis, adherence ± SD to one time-daily dosing was found to be 79%±14%; to twice-daily dosing, 69%±15%; to dosing 3 times per twenty-four hour period, 65%±sixteen% (P=.008 vs once-daily); and to dosing iv times per solar day, 51%±20% (P<.001 vs once-daily; P=.001 vs twice-daily dosing) (Figure 3).3,86 These data propose that a x% decrease in adherence volition occur with each additional daily dose. Because complex treatment regimens are associated with decreased adherence,79 physicians would exist wise to prescribe drugs that can be taken at the same time of mean solar day. If circuitous treatment regimens cannot be avoided, open acknowledgement of this by the physician may meliorate the physician-patient relationship, thus increasing adherence.
Adherence to medication according to frequency of doses. Vertical lines represent 1 SD on either side of the hateful rate of adherence (horizontal bars).
From North Engl J Med,3 with permission from the Massachusetts Medical Society. All rights reserved.
When prescribing a new medication, the physician should provide the patient with all necessary and important information, including the proper noun of the medication; its purpose (eg, to lower BP); the rationale for choosing it (eg, other drugs are bachelor to lower your BP, but this one is every bit effective and is bachelor on your insurance program'due south formulary list); the frequency of dosing (eg, once daily); when it should exist taken (eg, in the morning with your other medications); how long it should be taken (eg, for 1 year or lifelong); and any potential adverse furnishings, their likelihood of occurring, whether they will resolve without intervention, and how the treatment plan may change if they do non resolve. Unfortunately, physicians often fail to communicate all of this data to their patients. In 1 written report, Tarn et al87 plant that in more than 65% of audiotaped cases they analyzed, physicians had omitted at to the lowest degree one piece of critical information when discussing a new medication with a patient.87 Teaching regarding the duration of medication utilise was lowest (17%) for cardiovascular medications.87
Patients' perceptions of adverse furnishings contribute significantly to decisions regarding medication adherence. In a written report of patients with hypertension, agin effects were listed equally the most mutual concern among patients who were non adherent to their antihypertensive medication.88 Nonadherence to medications secondary to adverse effects is termed rational nonadherence, which Garner89 defines as "the abeyance of a prescribed therapy because of concern for, or the presence of, medication side effects." Garner farther states that rational nonadherence "is nearly impossible to circumvent if a patient'southward specific side-effect concerns are not essentially addressed." Therefore, it is critical that adverse effect profiles are considered when prescribing a medication and discussed with the patient before the initial prescription and at every visit thereafter.
Using the teach-back approach (ie, asking patients to echo the important points) and request patients to read and interpret the medication label are ways in which the physician can confirm that patients empathise all aspects of their new medication, which in plough increases adherence. Patient medication lists with pictograms are helpful and are bachelor at sites listed in Table ane. Use of motivational interviewing is some other effective advice tool. Motivational interviewing, a counseling technique originally developed to help care for habit, is designed to help patients identify and overcome reasons they may exist reluctant to change their behavior.90 A meta-analysis of 72 randomized controlled trials showed significant benefit for motivational interviewing in achieving cholesterol and BP control, with psychologists and physicians able to accomplish an effect in 80% of the studies.91 A randomized trial conducted in 190 African Americans with hypertension showed that the improver of motivational interviewing led to steady maintenance of adherence during a i-yr menstruation, in dissimilarity to the control group, in which adherence rates declined significantly.92
Health Arrangement/Team Edifice–Related Factors
The wellness system in which a physician practices is integral to achieving the ultimate goal of improved patient health. Because medication adherence is an important contributor to improved patient health, wellness care systems must evolve in a way that emphasizes its importance. Wellness system changes are necessary to ensure that sufficient fourth dimension is allotted to discussing aspects of medication adherence.93 Time constraints may be addressed by developing a team-based approach to health intendance (Table 1). The team-based approach includes training nonphysician staff to perform duties traditionally completed past physicians, thus assuasive the physician more time to talk over the patient's medication adherence patterns. For example, during a phone reminder for an upcoming appointment, clerical staff might remind patients to bring in all their medications and pill boxes for review at the part engagement. Other aspects of a team-based arroyo to health care include assessment of nonadherence by role staff and pharmacists, pharmacist-based patient education, phone phone call reminders, Spider web-based tools, and assignment of a case manager. Because these activities occur outside of the doctor-patient encounter, they will not lengthen the visit and may increment efficiency. The importance of a team-based arroyo to managing medication use is highlighted past the medication therapy management services (MTMS) mandated by the 2003 Medicare Prescription Drug Comeback and Modernization Human activity.94 Medication therapy management services, which are provided by insurers mainly through community-based pharmacists, are designed to provide education and counseling to improve patient understanding of their medications, ameliorate medication adherence, and observe adverse drug reactions. Preliminary studies suggest that patient participation in MTMS programs improves medication adherence and patient outcomes95-97; thus, physicians should encourage eligible patients to participate in MTMS programs.
Increased implementation of electronic medical records and electronic prescribing has the potential to increase adherence by identifying patients at run a risk of nonadherence and targeting them for intervention. A large U.s. report showed that a greater than 30-day delay in filling an initial prescription for a statin independently predicted medication nonadherence.98 Yet, increased use of electronic records would allow for the implementation of systems that could place delayed filling on an initial prescription, thus allowing the physician to intervene and perhaps foreclose poor adherence. Some pharmacies already employ automated reminders to alarm patients that their prescriptions should be refilled and remind physicians to contact their patients who practice not refill their prescriptions.
Initiating long-term medications during hospitalization for an acute effect, rather than beginning therapy after belch, may improve adherence. In a postal service hoc assay of the EPILOG (Evaluation of PTCA to Meliorate Long-term Outcome) trial of patients undergoing percutaneous coronary intervention, those prescribed lipid-lowering therapy while hospitalized were 3 times more likely than those prescribed therapy after hospital release to be adherent at 6 months.99 Initiating therapy while patients are hospitalized is thought to ameliorate adherence because patients and their caregivers are focused on cardiovascular take chances and how information technology tin be reduced during this "teachable moment."100 Many patients perceive that medications initiated while they are in the hospital are essential for their health.100
A critically important wellness system–related factor that improves medication adherence, as well every bit patient safety, is appropriate medication reconciliation. Medication reconciliation is the process of creating the virtually accurate listing possible of all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing that list against admission, transfer, and/or discharge orders. The goal of medication reconciliation, a national priority of the Joint Committee on Accreditation of Healthcare Organizations, is to ensure provision of correct medications to patients at all transition points and avert medication duplication and errors.101 On the basis of the observation that primary care physicians do not receive the hospital discharge summary before the patient's adjacent contact or treatment 66% of the time,68 much greater emphasis on medication reconciliation is needed if medication adherence and patient safety are to improve. An important component of the reconciliation process is the apply of a personalized, upto-engagement medication list for patients to keep with them at all times (for sources of downloadable medication lists, see Table 1). These personalized medication lists are particularly important for patients with chronic conditions such as CVD, which typically necessitate the use of multiple medications. By reviewing medication lists at every visit, physicians can ensure that other physicians have not prescribed new medications without their noesis. For example, if a patient is seeing his or her primary care physician for the outset time after an MI, an updated medication listing volition help ensure that the primary care physician is aware of whatever new medications. Furthermore, the list can serve equally a basis to discuss bodily medication usage patterns with the patient.
Decision
Strong evidence shows that many patients with chronic illnesses have difficulty adhering to their recommended medication regimen. Assertive that medication nonadherence is the "mistake" of the patient is an uninformed and destructive model that is best abandoned. As the former Surgeon General C. Everett Koop reminded us, "Drugs don't piece of work in patients who don't accept them."3 Thus, physicians must recognize that poor medication adherence contributes to suboptimal clinical benefits, particularly in lite of the WHO's statement that increasing adherence may have a greater effect on health than any improvement in specific medical treatments.1 The multifactorial nature of poor medication adherence implies that only a sustained, coordinated endeavor volition ensure optimal medication adherence and realization of the full benefits of current therapies. Current recognition of the importance of medication adherence has resulted in the development of many useful Web-based resources.
Supplementary Material
Acknowledgments
Editorial assist with searching the literature, coordinating revisions, and creating figures and tables in preparation of this manuscript was provided by Melanie Leiby, PhD, and additional assistance with correspondence and permissions was provided by Barbara A. Tater, both of inScience Communications, a Wolters Kluwer business, and funded by the Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership. The authors would like to give thanks Joyce Pallinger, MS, MLIS, Manager, and Karly Vesely, MLIS, Medical Librarian, of the MacNeal Hospital Library for boosted support in obtaining references.
Footnotes
An earlier version of this commodity appeared Online Outset.
REFERENCES
1. Sabaté E, ed. Adherence to Long-Term Therapies: Evidence for Activeness . Geneva, Switzerland: Earth Wellness System; 2003. [Google Scholar]
two. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy intendance programme on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA . 2006;296(21):2563-2571 [PubMed] [Google Scholar]
iii. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(five):487-497 [PubMed] [Google Scholar]
4. Huth EJ, Murray TJ, eds. Medicine in Quotations: Views of Wellness and Disease Through the Ages . 2d ed. Philadelphia, PA: American College of Physicians; 2006. [Google Scholar]
5. Steiner JF, Earnest MA. The linguistic communication of medication-taking. Ann Intern Med. 2000;132(11):926-930 [PubMed] [Google Scholar]
6. Winkler A, Teuscher AU, Mueller B, Diem P. Monitoring adherence to prescribed medication in type two diabetic patients treated with sulfonylureas. Swiss Med Wkly. 2002;132(27-28):379-385 [PubMed] [Google Scholar]
7. Lewington Southward, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual claret force per unit area to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet . 2002;360(9349):1903-1913 [PubMed] [Google Scholar]
eight. Smith SC, Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular affliction: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation . 2006;113(nineteen):2363-2372 [PubMed] [Google Scholar]
nine. Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet NeUrol. 2009;viii(v):453-463 [PubMed] [Google Scholar]
x. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering handling: prospective meta-analysis of data from xc,056 participants in 14 randomised trials of statins. Lancet . 2005;366(9493):1267-1278 [PubMed] [Google Scholar]
eleven. Police MR, Morris JK, Wald NJ. Use of claret pressure lowering drugs in the prevention of cardiovascular disease: meta-assay of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665 http://world wide web.ncbi.nlm.nih.gov/pmc/articles/PMC2684577/ Published May 19, 2009. Accessed November 12, 2009 [PMC gratis commodity] [PubMed] [Google Scholar]
12. Glader EL, Sjölander M, Eriksson M, Lundberg M. Persistent utilise of secondary preventive drugs declines rapidly during the first ii years after stroke. Stroke . 2010;41(2):397-401 [PubMed] [Google Scholar]
13. Costa FV. Compliance with antihypertensive treatment. Clin Exp Hypertens. 1996;18(3-4):463-472 [PubMed] [Google Scholar]
14. Cramer JA, Bridegroom A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62(one):76-87 [PMC complimentary article] [PubMed] [Google Scholar]
xv. Elliott WJ. What factors contribute to the inadequate control of elevated blood force per unit area? J Clin Hypertens (Greenwich) . 2008;10(1, suppl i):20-26 [PMC free article] [PubMed] [Google Scholar]
sixteen. Ho PM, Magid DJ, Shetterly SM, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary avenue disease. Am Centre J. 2008;155(4):772-779 [PubMed] [Google Scholar]
17. Kettani FZ, Dragomir A, Cote R, et al. Touch of a improve adherence to antihypertensive agents on cerebrovascular disease for primary prevention. Stroke . 2009;twoscore(1):213-220 [PubMed] [Google Scholar]
18. Mazzaglia 1000, Ambrosioni E, Alacqua Yard, et al. Adherence to antihypertensive medications and cardiovascular morbidity amid newly diagnosed hypertensive patients. Circulation . 2009;120(xvi):1598-1605 [PubMed] [Google Scholar]
19. Adams RJ, Albers Thou, Alberts MJ, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic set on. Stroke . 2008;39(v):1647-1652 [PMC gratuitous article] [PubMed] [Google Scholar]
20. Kushner FG, Manus M, Smith SC, Jr, et al. 2009 Focused Updates: ACC/AHA Guidelines for the management of patients with ST-peak myocardial infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on percutaneous coronary intervention (Updating the 2005 Guideline and 2007 Focused Update): a study of the American Higher of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation . 2009;120(22):2271-2306 [PubMed] [Google Scholar]
21. Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther. 2007;21(4):311-316 [PubMed] [Google Scholar]
22. Deambrosis P, Saramin C, Terrazzani One thousand, et al. Evaluation of the prescription and utilization patterns of statins in an Italian local health unit during the catamenia 1994-2003. Eur J Clin Pharmacol. 2007;63(2):197-203 [PubMed] [Google Scholar]
23. Perreault S, Dragomir A, Blais L, et al. Affect of better adherence to statin agents in the chief prevention of coronary artery affliction. Eur J Clin Pharmacol. 2009;65(10):1013-1024 [PubMed] [Google Scholar]
24. Poluzzi E, Strahinja P, Lanzoni One thousand, et al. Adherence to statin therapy and patients' cardiovascular take chances: a pharmacoepidemiological study in Italy. Eur J Clin Pharmacol. 2008;64(iv):425-432 [PubMed] [Google Scholar]
25. Chodick 1000, Shalev V, Gerber Y, et al. Long-term persistence with statin treatment in a non-for-profit health maintenance organization: a population-based retrospective accomplice report in Israel. Clin Ther. 2008;30(11):2167-2179 [PubMed] [Google Scholar]
26. Evans CD, Eurich DT, Lamb DA, et al. Retrospective observational assessment of statin adherence among subjects patronizing different types of community pharmacies in Canada. J Manag Care Pharm. 2009;15(vi):476-484 [PubMed] [Google Scholar]
27. National Cholesterol Educational activity Program (NCEP) Skillful Panel Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of Loftier Claret Cholesterol in Adults (Adult Treatment Panel Iii) final study. Circulation . 2002;106(25):3143-3421 [PubMed] [Google Scholar]
28. Waters DD, Brotons C, Chiang CW, et al. Lipid handling assessment project 2: a multinational survey to evaluate the proportion of patients achieving depression-density lipoprotein cholesterol goals. Circulation . 2009;120(1):28-34 [PubMed] [Google Scholar]
29. Kulkarni SP, Alexander KP, Lytle B, Heiss G, Peterson ED. Long-term adherence with cardiovascular drug regimens. Am Heart J. 2006;151(1):185-191 [PubMed] [Google Scholar]
30. Newby LK, LaPointe NM, Chen AY, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary avenue disease. Circulation . 2006;113(2):203-212 [PubMed] [Google Scholar]
31. Hamann GF, Weimar C, Glahn J, Busse O, Diener HC. Adherence to secondary stroke prevention strategies: results from the German Stroke Data Banking concern. Cerebrovasc Dis. 2003;15(4):282-288 [PubMed] [Google Scholar]
32. Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy discontinuation on mortality later myocardial infarction. Arch Intern Med. 2006;166(17):1842-1847 [PubMed] [Google Scholar]
33. Melloni C, Alexander KP, Ou FS, et al. Predictors of early on discontinuation of evidence-based medicine after acute coronary syndrome. Am J Cardiol. 2009;104(2):175-181 [PubMed] [Google Scholar]
34. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy subsequently drug-eluting stent placement: results from the PREMIER registry. Circulation . 2006;113(24):2803-2809 [PubMed] [Google Scholar]
35. Pallares MJ, Powers ER, Zwerner PL, Fowler A, Reeves R, Nappi JM. Barriers to clopidogrel adherence following placement of drug-eluting stents. Ann PharmacoTher. 2009;43(ii):259-267 [PubMed] [Google Scholar]
36. Roy P, Bonello Fifty, Torguson R, et al. Temporal relation betwixt clopidogrel cessation and stent thrombosis later drug-eluting stent implantation. Am J Cardiol. 2009;103(vi):801-805 [PubMed] [Google Scholar]
37. Lesaffre E, Kocmanova D, Lemos PA, Disco CM, Serruys PW. A retrospective analysis of the effect of noncompliance on time to first major adverse cardiac outcome in LIPS. Clin Ther. 2003;25(9):2431-2447 [PubMed] [Google Scholar]
38. Perreault South, Ellia L, Dragomir A, et al. Effect of statin adherence on cerebrovascular disease in primary prevention. Am J Med. 2009;122(7):647-655 [PubMed] [Google Scholar]
39. Dragomir A, Côté R, White M, et al. Human relationship between adherence level to statins, clinical issues and health-care costs in existent-life clinical setting. Value Wellness . 2010;13(1):87-94 [PubMed] [Google Scholar]
forty. Wiederkehr D, Ogbonnaya A, Casciano R, Makenbaeva D, Mozaffari East, Corbelli J. Clinical impact of early on clopidogrel discontinuation following astute myocardial infarction hospitalization or stent implantation: analysis in a nationally representative managed-care population. Curr Med Res Opin . 2009;25(9):2327-2334 [PubMed] [Google Scholar]
41. Biondi-Zoccai GG, Lotrionte M, Agostoni P, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among l,279 patients at risk for coronary artery affliction. Eur Heart J. 2006;27(22):2667-2674 [PubMed] [Google Scholar]
42. Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel utilise and long-term clinical outcomes after drug-eluting stent implantation. JAMA . 2007;297(2):159-168 [PubMed] [Google Scholar]
43. Airoldi F, Colombo A, Morici N, et al. Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment. Circulation . 2007;116(vii):745-754 [PubMed] [Google Scholar]
44. Iakovou I, Schmidt T, Bonizzoni East, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA . 2005;293(17):2126-2130 [PubMed] [Google Scholar]
45. van Werkum JW, Heestermans AA, Zomer Air-conditioning, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol. 2009;53(sixteen):1399-1409 [PubMed] [Google Scholar]
46. Ryan AA. Medication compliance and older people: a review of the literature. Int J Nurs Stud. 1999;36(ii):153-162 [PubMed] [Google Scholar]
47. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed handling: clinical applications. JAMA . 2002;288(22):2880-2883 [PubMed] [Google Scholar]
48. Raynor DK. Medication literacy is a 2-way street [editorial]. Mayo Clin Proc. 2008;83(v):520-522 [PubMed] [Google Scholar]
49. Kindig D, Affonso D, Chudler E, et al. Health Literacy: a Prescription to End Confusion . Washington, DC: Institute of Medicine of the National Academies; 2004. [Google Scholar]
l. Bakery DW, Parker RM, Williams MV, Clark WS. Health literacy and the gamble of hospital admission. J Gen Intern Med. 1998;13(12):791-798 [PMC free article] [PubMed] [Google Scholar]
51. Mancuso CA, Rincon M. Touch of health literacy on longitudinal asthma outcomes. J Gen Intern Med. 2006;21(8):813-817 [PMC gratis commodity] [PubMed] [Google Scholar]
52. Brunner R, Dunbar-Jacob J, Leboff MS, et al. Predictors of adherence in the Women's Health Initiative Calcium and Vitamin D Trial. Behav Med. 2009;34(iv):145-155 [PMC complimentary article] [PubMed] [Google Scholar]
53. Joyner-Grantham J, Mount DL, McCorkle OD, Simmons DR, Ferrario CM, Cline DM. Cocky-reported influences of hopelessness, health literacy, life-style action, and patient inertia on claret pressure level control in a hypertensive emergency section population. Am J Med Sci. 2009;338(5):368-372 [PubMed] [Google Scholar]
54. Achieve Thousand. Is there an impatience genotype leading to non-adherence to long-term therapies? Diabetologia . 2010;53(8):1562-1567 [PubMed] [Google Scholar]
55. Kripalani S, Henderson LE, Jacobson TA, Vaccarino V. Medication use amongst inner-city patients later on hospital discharge: patient-reported barriers and solutions. Mayo Clin Proc. 2008;83(5):529-535 [PubMed] [Google Scholar]
56. Molloy GJ, Perkins-Porras Fifty, Bhattacharyya MR, Strike PC, Steptoe A. Practical support predicts medication adherence and attendance at cardiac rehabilitation following astute coronary syndrome. J Psychosom Res. 2008;65(6):581-586 [PubMed] [Google Scholar]
57. Molloy GJ, Perkins-Porras L, Strike PC, Steptoe A. Social networks and partner stress as predictors of adherence to medication, rehabilitation omnipresence, and quality of life following astute coronary syndrome. Wellness Psychol. 2008;27(one):52-58 [PubMed] [Google Scholar]
58. Kronish IM, Rieckmann North, Halm EA, et al. Persistent depression affects adherence to secondary prevention behaviors afterward acute coronary syndromes. J Gen Intern Med. 2006;21(xi):1178-1183 [PMC free article] [PubMed] [Google Scholar]
59. Sundel KL, Stain-Mahngren R, Andersson A, Aberg-Wistedt A, Schenck-Gustafsson K. High frequency of anxiety and angina pectoris in depressed women with coronary heart disease. Gend Med. 2007;4(2):146-156 [PubMed] [Google Scholar]
60. Amin AA, Jones AM, Nugent K, Rumsfeld JS, Spertus JA. The prevalence of unrecognized depression in patients with acute coronary syndrome. Am Heart J. 2006;152(5):928-934 [PubMed] [Google Scholar]
61. Dafer RM, Rao Yard, Shareef A, Sharma A. Poststroke depression. Summit Stroke Rehabil. 2008;xv(one):13-21 [PubMed] [Google Scholar]
62. Frasure-Smith Northward, Lespérance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry . 2008;65(1):62-71 [PubMed] [Google Scholar]
63. Jia H, Damush TM, Qin H, et al. The bear upon of poststroke depression on healthcare use by veterans with astute stroke. Stroke . 2006;37(xi):2796-2801 [PubMed] [Google Scholar]
64. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and main intendance physicians: implications for patient safety and continuity of care. JAMA . 2007;297(8):831-841 [PubMed] [Google Scholar]
65. Winterstein AG, Sauer BC, Hepler CD, Poole C. Preventable drug-related hospital admissions. Ann PharmacoTher. 2002;36(7-viii):1238-1248 [PubMed] [Google Scholar]
66. Gordon K, Smith F, Dhillon S. Effective chronic disease direction: patients' perspectives on medication-related problems. Patient Educ Couns . 2007;65(3):407-415 [PubMed] [Google Scholar]
67. Kennedy J, Tuleu I, Mackay K. Unfilled prescriptions of medicare beneficiaries: prevalence, reasons, and types of medicines prescribed. J Manag Care Pharm. 2008;xiv(6):553-560 [PubMed] [Google Scholar]
68. Bodenheimer T. Coordinating care: a perilous journeying through the health intendance arrangement. N Engl J Med. 2008;358(10):1064-1071 [PubMed] [Google Scholar]
69. Haynes RB, Ackloo Eastward, Sahota Due north, McDonald HP, Yao Ten. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;(2):CD000011 [PubMed] [Google Scholar]
70. Schillinger D, Piette J, Grumbach One thousand, et al. Endmost the loop: dr. communication with diabetic patients who accept low health literacy. Arch Intern Med. 2003;163(1):83-90 [PubMed] [Google Scholar]
71. Roumie CL, Elasy TA, Greevy R, et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med. 2006;145(3):165-175 [PubMed] [Google Scholar]
72. Balamurugan A, Ohsfeldt R, Hughes T, Phillips M. Diabetes self-direction education plan for Medicaid recipients: a continuous quality improvement process. Diabetes Educ. 2006;32(vi):893-900 [PubMed] [Google Scholar]
73. Praska JL, Kripalani S, Seright AL, Jacobson TA. Identifying and profitable depression-literacy patients with medication apply: a survey of community pharmacies. Ann PharmacoTher. 2005;39(9):1441-1445 [PubMed] [Google Scholar]
74. US Department of Health and Human being Services. Role of Disease Prevention and Health Promotion America'due south health literacy: why we need attainable health information. Bethesda, Md: US Dept of Health and Human Services; 2008. http://www.health.gov/communication/literacy/issuebrief/ Accessed November 15, 2010 [Google Scholar]
75. United states Department of Wellness and Man Services. National Institutes of Health Clear communication: an NIH wellness literacy initiative. Bethesda, MD: National Institutes of Health; 2010. http://www.nih.gov/clearcommunication/ Accessed Nov 15, 2010 [Google Scholar]
76. Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns . 1996;27(ane):33-39 [PubMed] [Google Scholar]
77. Perez-Stable EJ, Salazar R. Issues in achieving compliance with antihypertensive treatment in the Latino population. Clin Cornerstone . 2004;6(3):49-61 [PubMed] [Google Scholar]
78. Urquhart J. Patient non-compliance with drug regimens: measurement, clinical correlates, economic impact. Eur Heart J. 1996;17(suppl A):8-15 [PubMed] [Google Scholar]
79. Odegard PS, Capoccia K. Medication taking and diabetes: a systematic review of the literature. Diabetes Educ. 2007;33(6):1014-1029 [PubMed] [Google Scholar]
80. Chapman RH, Petrilla AA, Benner JS, Schwartz JS, Tang SS. Predictors of adherence to concomitant antihypertensive and lipid-lowering medications in older adults: a retrospective, cohort report. Drugs Aging . 2008;25(10):885-892 [PubMed] [Google Scholar]
81. Benner JS, Chapman RH, Petrilla AA, Tang SS, Rosenberg N, Schwartz JS. Clan between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapy. Am J Health Syst Pharm. 2009;66(16):1471-1477 [PubMed] [Google Scholar]
82. Bangalore Due south, Kamalakkannan G, Parkar S, Messerli FH. Fixed-dose combinations amend medication compliance: a meta-analysis. Am J Med. 2007;120(viii):713-719 [PubMed] [Google Scholar]
83. Balu S, Simko RJ, Quimbo RM, Cziraky MJ. Impact of stock-still-dose and multi-pill combination dyslipidemia therapies on medication adherence and the economical brunt of sub-optimal adherence. Curr Med Res Opin. 2009;25(11):2765-2775 [PubMed] [Google Scholar]
84. Hussein MA, Chapman RH, Benner JS, et al. Does a single-pill antihypertensive/lipid-lowering regimen improve adherence in US managed care enrolees? A not-randomized, observational, retrospective study. Am J Cardiovasc Drugs . 2010;10(iii):193-202 [PubMed] [Google Scholar]
85. Schroeder 1000, Fahey T, Ebrahim S. How can nosotros amend adherence to blood pressure-lowering medication in convalescent care? Systematic review of randomized controlled trials. Arch Intern Med. 2004;164(vii):722-732 [PubMed] [Google Scholar]
86. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-1310 [PubMed] [Google Scholar]
87. Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS. Physician communication when prescribing new medications. Arch Intern Med. 2006;166(17):1855-1862 [PubMed] [Google Scholar]
88. Svensson S, Kjellgren KI, Ahlner J, Säljö R. Reasons for adherence with antihypertensive medication. Int J Cardiol. 2000;76(2-3):157-163 [PubMed] [Google Scholar]
89. Garner JB. Problems of nonadherence in cardiology and proposals to better outcomes. Am J Cardiol. 2010;105(x):1495-1501 [PubMed] [Google Scholar]
90. Miller NH. Motivational interviewing as a prelude to coaching in healthcare settings. J Cardiovasc Nurs. 2010;25(3):247-251 [PubMed] [Google Scholar]
91. Rubak South, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305-312 [PMC free article] [PubMed] [Google Scholar]
92. Ogedegbe Thou, Chaplin West, Schoenthaler A, et al. A exercise-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens. 2008;21(x):1137-1143 [PMC free article] [PubMed] [Google Scholar]
93. Abbo ED, Zhang Q, Zelder M, Huang ES. The increasing number of clinical items addressed during the time of adult primary intendance visits. J Gen Intern Med. 2008;23(12):2058-2065 [PMC gratis article] [PubMed] [Google Scholar]
94. Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Pub L No. 108-173, 117 Stat 2066
95. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs . 2009;69(4):393-406 [PubMed] [Google Scholar]
96. Trick D, Ried LD, Klein GE, Myers W, Foli G. A medication therapy management program's impact on low-density lipoprotein cholesterol goal attainment in Medicare Function D patients with diabetes. J Am Pharm Assoc (2003). 2009;49(2):192-199 [PubMed] [Google Scholar]
97. Planas LG, Crosby KM, Mitchell KD, Farmer KC. Evaluation of a hypertension medication therapy management plan in patients with diabetes. J Am Pharm Assoc (2003). 2009;49(ii):164-170 [PubMed] [Google Scholar]
98. Yu AP, Yu YF, Nichol MB, Gwadry-Sridhar F. Delay in filling the initial prescription for a statin: a potential early indicator of medication nonpersistence. Clin Ther. 2008;30(iv):761-774, word 716 [PubMed] [Google Scholar]
99. Aronow HD, Novaro GM, Lauer MS, et al. In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis. Arch Intern Med. 2003;163(21):2576-2582 [PubMed] [Google Scholar]
100. Fonarow GC. In-hospital initiation of statins: taking advantage of the 'teachable moment' [editorial]. Cleve Clin J Med. 2003;70(6):502, 504-506 [PubMed] [Google Scholar]
101. Joint Commission on Accreditation of Healthcare Organizations Using medication reconciliation to prevent errors. Lookout Event Warning . 2006;(35):1-4 [PubMed] [Google Scholar]
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