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2.
Patient Educ Couns ; 100(7): 1410-1414, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28214168

RESUMO

OBJECTIVES: Medication adherence is a complex problem and can be evaluated using a variety of methods. There is no single or perfect strategy to assess adherence. The "best" measure depends on contextual factors. Our objective is to provide a practical, illustrative guide for selecting the most appropriate measure of medication adherence in common contexts. METHODS: We present three case studies - from the perspectives of an academic researcher, health care payer, and clinical care provider - to describe common problems and processes for measuring medication adherence, as well as proposing possible solutions. RESULTS: The most appropriate measure will depend on the context (tightly controlled clinical trial setting vs. clinical setting), intended purpose (research vs. clinical), available resources (data, personnel, materials, and funding), time (quick screening vs. comprehensive review), and phase of interest (initiation, implementation, or discontinuation). Framing the problem of medication non-adherence and methods for measuring adherence are discussed using three representative case studies. CONCLUSIONS: A simple tool is provided that may help stakeholders interested in medication adherence make decisions regarding the appropriate selection of measures. PRACTICE IMPLICATIONS: A medication adherence measure should be selected through the lens of each situation's unique objectives, resources, and needs.


Assuntos
Guias como Assunto , Adesão à Medicação , Humanos
3.
J Gen Intern Med ; 32(1): 93-100, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27599489

RESUMO

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions.


Assuntos
Adesão à Medicação/psicologia , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Doença Crônica/terapia , Tomada de Decisões , Feminino , Humanos , Hipertensão/tratamento farmacológico , Pessoa de Meia-Idade , Entrevista Motivacional/métodos , Padrões de Prática Médica , Atenção Primária à Saúde
4.
JMIR Med Inform ; 4(1): e9, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26980270

RESUMO

BACKGROUND: The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. OBJECTIVE: The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. METHODS: We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. RESULTS: The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. CONCLUSION: To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

5.
Patient Prefer Adherence ; 8: 1025-34, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25114513

RESUMO

Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications.

6.
Am Heart J ; 162(3): 412-24, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21884856

RESUMO

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Serviços de Saúde Comunitária/métodos , Serviços Comunitários de Farmácia/organização & administração , Adesão à Medicação/estatística & dados numéricos , Fármacos Cardiovasculares/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Custos de Medicamentos , Honorários Farmacêuticos/tendências , Humanos , Morbidade/tendências , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
7.
Postgrad Med ; 122(4): 192-9, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20675982

RESUMO

The objective of this article is to review the evidence basis for short-term risk assessments of overall coronary heart disease (CHD) burden as compared with lifetime risk estimates of CHD, based on the current medical literature. We reviewed literature published in the last 6 years using the terms "cardiovascular prevention," "Framingham risk scoring," "lifetime risk," and "cardiovascular risk assessment," and subsequently evaluated 98 publications to determine the variation in these approaches to estimate cardiovascular risk factors and impact on clinical decision making. The current evidence base suggests that lifetime risk estimates offset the significant impact of age on traditional, short-term risk estimates of cardiovascular risk. We conclude that the use of lifetime risk estimates may be more clinically meaningful than traditional, short-term risk estimates to assess an individual's overall risk burden, and may prevent the potential delay of therapeutic interventions to reduce cardiovascular events. For primary care, this difference may be of relevance to patients and should be communicated to them.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Prevenção Primária , Medição de Risco , Comportamento de Redução do Risco , Humanos
8.
J Clin Lipidol ; 2(1): 51-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21291715

RESUMO

BACKGROUND: Statins are commonly used to reduce the risk of heart attacks and strokes. Despite the benefit and limited risks in properly identified patients, clinicians are often challenged by patient acceptance and adherence to these medications. OBJECTIVES: To assess if patients and physicians may have unfounded safety concerns about hepatotoxicity from these medications, we surveyed physicians and patients. RESULTS: We found inconsistent liver function-monitoring practices as well as exaggerated fears of statin-induced hepatotoxicity. Patients who received risk information from their physician were more likely to accurately estimate hepatotoxic risk than patients receiving such information from other sources. CONCLUSIONS: We believe these misperceptions about the relative risk and benefits of statin therapy are propagated by direct-to-consumer advertising, which may emphasize potential adverse events relative to treatment benefits. These perceptions are likely to adversely affect statin adherence, and may be addressed by patient education.

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