Enhancing patient adherence
"Who can remember when and whether all those medications were taken?"
An extensive analysis of the data in the Pharmionic Knowledge Centre has revealed major findings in ambulatory patients' adherence. Patterns of deviation from prescribed dosing regimens vary widely across individual subjects, but are almost entirely markedly skewed toward longer dosing intervals than prescribed, i.e. under-dosing, in every field of treatment. Delayed doses, forgotten doses, drug holidays (3 or more consecutive days without drug intake), and early cessation of dosing are common and natural features in ambulatory patients. It is likely that they constitute frequent sources of low response and high variability in response to the prescribed dosing regimen. Suboptimal adherence can severely compromise the efficacy of treatment.
Successful techniques for improving adherence have revealed the requirement for three key elements:
- a reliable, objective drug dosing history, including day by day dosing times, presented in a format that can be easily interpreted by most patients;
- periodic review with the patient, by the prescribing physician, pharmacist, or nurse, of the patient’s dosing history since the last visit. This approach, called Measurement-Guided Medication Management (MGMM), is a clear break with past attempts to improve compliance based on unsatisfactory methods of measurement that depend on the patient’s recall or timely diary entries and afford the patient the easy ability to exaggerate his/her compliance;
- statistical projection of the likelihood that the patient will soon discontinue the prescribed treatment.
