To ‘see both sides’ of a problem is the surest way to prevent its complete solution. Because there are always more than two sides.
- Idries Shah
Typically the target audience for this blog is for caregivers, but I’m going to take a short break from that and focus on people looking to provide solutions to the consumption or medication compliance part of the problem.
Strict “adherence” is the goal set out for patients, which is the practice of taking the medication as prescribed. (I’ll explain why I’m not a fan of that word in other post.) One reason why adherence is so elusive is because of the complexity in a polypharmacy situation with many prescribed drugs. Here’s a graphic to illustrate some of the many of the factors when looking at the problem as a system. The focus here is on consumption as prescribed and presumes all medication is appropriate for the patient and affordable which, I grant you, are two big assumptions. Even with those simplifying assumption, the landscape is still very full:
We can look at them in 5 broad groups.
Patient’s Health and Treatment plan
- Multiple Conditions – the more things a patient is being treated for the harder it is for them to stay on top of properly.
- Complexity of Regime – as the number of pills, the number of times a day to dose, and the number of constraints (what to take with or not take with) increases, the hard it is to manage.
- Medication Changes – the ability to adjust to a new routine when the dose is increased or decreased, or a medication added or removed.
- Forgetfulness – medication can be forgotten because life gets busy for all of us.
- Cognitive Impairments – loss of memory or mental abilities, sometimes age-related but sometimes as a transitional state to more serious disease such as Alzheimer’s, can make it hard to remember what you are supposed to do or why.
- Vision Impairments – limitations of eyesight can make it hard to read the dose or instructions on the pill bottles
- Motor Impairments – physical handicaps, in the hands for example, can make it difficult to open pill bottles
- Ability to Navigate Healthcare System – coordinating doctors and pharmacists, arranging doctors’ visits, keep records, dealing with refills, insurance, etc.
Patient’s Living Situation
- Living Alone – living alone or without a support system can make medication-related tasks like filling the pillbox, programming reminders, or learning new technology more challenging.
- No Technology Infrastructure – While some interesting technology solution exist to help with medication management, not all homes have a computer or are ‘wired’.
- Discontinued Due to Lack of Symptoms – A patient may associate a lack of symptoms with being ‘cured’ and the medication no longer necessary.
- Cultural and Belief Systems – beliefs around self-efficacy, control, medication effectiveness, confidence in the physician’s knowledge, perceptions about natural and home remedies can significantly drive medication-taking behavior.1
- Patient’s Understanding of Disease – A patient who understands why treatment is important and the risk / reward of medication may be more motivated to take the medication.
- Multiple Doctors – When a patient is treated by more than one doctor, the responsibility to help everyone understand the whole picture often falls on the patient.
- Multiple Pharmacies – Filling prescriptions in multiple places can make it harder to ensure the right medications are on hand, and additionally can make checking for drug interactions more challenging.
So given this complex landscape, what are the possible solutions? A study by NEHI concluded that
[P]romising adherence strategies are invariably multi-component strategies. They do not rely on single ‘silver bullet’ interventions but typically involve a suite of interventions or services.
Read the entire NEHI article for more of their insight.
Until Next Time,