Medication adherence in a nurse practitioner managed clinic for indigent patients

Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions

BACKGROUND

Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States.

OBJECTIVE

To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease.

METHODS

A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence.

RESULTS

A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59).

CONCLUSIONS

Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.

A narrative review on do's and don'ts in prescription label writing - lessons for pharmacists

Providing medicines information is a key role of a pharmacist. Miscommunication between pharmacist and patient may lead to adverse drug events or therapeutic failure. The aim of the review was to summarize the available research findings on factors that lead to poor communication between pharmacist and patient when providing written medicines information on dispensing and auxiliary labels and identify successful interventional approaches that help to alleviate these concerns. We selected articles available on PubMed, SAGE, and Google Scholar databases that are relevant to our objective. A total of 33 articles that matched the objectives of this review were retrieved and evaluated by all three authors. It was found that patient literacy levels, number of medicines dispensed, format and organization of the label, complexity of dosing instructions, precision of writing dosing instructions and use of icons, graphics and pictograms were aspects that were frequently used, and hence assessed by research groups on medicine label writing. Most studies reported that simple and straight forward instructions written legibly were better comprehended by patients. Based on our findings, we provide here useful tips for pharmacists on writing dosing instructions for patients. Finally, we spotlight crucial research gaps related to communicating written dosing instructions that need to be addressed in the future.

Evaluation of medication adherence in chronic disease at a federally qualified health center

BACKGROUND

While medication adherence in chronic disease has been evaluated in the general population, limited data are available among Medicaid recipients, especially within federally qualified health centers (FQHCs). This study determined baseline medication adherence for Medicaid recipients receiving care in an FQHC for first-line medications used in hypertension, hyperlipidemia, and diabetes. Secondary outcomes included baseline adherence for individual patient factors.

METHODS

Patients from the Salud Family Health Centers, an FQHC with a large percentage of both Spanish-speaking patients and providers, were included in this study. Using retrospective prescription claims reports from 1 January 2015 to 1 October 2015, medication possession ratios (MPRs) and proportion of days covered (PDC) were calculated for each medication group. Patients with adherence ⩾0.80 were considered adherent.

RESULTS

From 1034 individual patients, 1788 medications were evaluated. Using MPRs, adherence rates were highest among medications for hypertension (67.2% adherent), followed by hyperlipidemia (67.0%), and lastly diabetes (58.0%); p < 0.001. Likewise, using PDC, adherence rates were highest for medications for hypertension (56.6%), followed by hyperlipidemia (52.2%), and lastly diabetes (45.0%); p = 0.010. Lower rates of adherence were seen among men, patients age 18-29 years old, African Americans, and patients with English documented as their preferred language.

CONCLUSIONS

Although overall medication adherence rates within our FQHC patients were comparable with those in previous literature, differences seen among medication groups and patient individual factors suggest that there is still much to be learned in improving adherence. Future efforts will require a multifaceted approach, tailored to patient-specific needs.