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Medication Adherence in Diabetes Mellitus: an Overview on Pharmacist Role S.Z

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Medication Adherence in Diabetes Mellitus: an Overview on Pharmacist Role S.Z American Journal of Advanced Drug Delivery www.ajadd.co.uk Review Article Medication Adherence in Diabetes Mellitus: An Overview on Pharmacist Role S.Z. Inamdar1*, R.V. Kulkarni1, S.R Karajgi1, F.V.Manvi2, M.S.Ganachari2, B.J.Mahendra Kumar2 1Department of Pharmacy practice BLDEA college of Pharmacy, Bijapur 586103 2Department of Pharmacy practice KLE college of Pharmacy, Belgaum 590001 Date of Receipt- 16/07/2013 ABSTRACT Date of Revision- 20/07/2013 Date of Acceptance- 26/07/2013 Diabetes mellitus is chronic disease where the medication regimen contains many aspects that make compliance difficult. Whatever is the efficacy of a drug, it cannot act unless the patient takes it. Treatment may be complex, intrusive and inconvenient. Many patients are prescribed very complicated regime of diet, exercise, and medication including several pills a day. Such complexity of treatment and factors like age, duration of diseases, depression, disabilities, psychosocial issues and life style changes directly or indirectly influences diseases self management. Adherence to treatment regimen is the key link between treatment and outcome in medical care. Low medication adherence has assumed importance as it seriously undermines the benefits of current medical care and imposes a significant financial burden on individual patients and the health care system as a whole. Poor adherence to the prescribed medication regimen is a critical health care concern for the health care providers all over the world. The problem of making sure the Address for patient follow prescriptions is as old as medicine itself. Pharmacist Correspondence can contribute and play major role in the assessment of patients S.Z Inamdar understanding of the illness and therapy, communicate the benefits or Asst Prof. treatment, assess the patient’s readiness to the care plan, and discuss BLDEA’s College of any barriers to adherence that patients may have. Medication Pharmacy adherence richly deserves attention and much impetus is needed to Bijapur 586103 develop new ideas and theories to improve it. WHO has emphasized Karanataka the pressing need to undertake more research in developing countries INDIA as data from developing country concerning the prevalence and E-mail: treatment adherence in diabetes patients are particularly scarce. syedzia.inamdar @gmail.com Keywords: Adherence, Diabetes Mellitus, Adherence barriers, Pharmacist, compliance American Journal of Advanced Drug Delivery www.ajadd.co.uk Inamdar et al___________________________________________________ISSN 2321-547X INTRODUCTION measure medication adherence, lack of experimental evidence for many models, In the fifth Century BC Hippocrates failure of measurement methods to gather reminded physicians ‘….to check patients valid information on the extent of patient behavior because often they lie about having adherence, uncertain reliability and validity taken prescribed drugs. This unadmitted of some scales used in medication adherence negligence may lead the physician into ’1-34 research studies, lack of patient centric error . information and lack of long term follow up Medication adherence is defined as data. High quality research studies in this the extent to which a patient medication area would perhaps establish the causes of taking behavior coincides with the intention medication non-adherence, and suggest of the health advice he or she has been strategies to improve medication adherence1- given. It is the most important factors that 3. determine therapeutic outcome, especially in patient suffering from chronic illness like 1 Adherence Importance diabetes mellitus . There are many situations in clinical Diabetes mellitus is term that practice where adherence is extremely describes a series of complex and chronic important for better therapeutic outcomes. heterogeneous metabolic disorder These include: characterized by symptomatic glucose Chronic diseases: such as diabetes and intolerance as well as disordered lipid and hypertension protein metabolism. Whatever is the Replacement therapy: e.g. Thyroxin and efficacy of drug it cannot act unless the insulin. patient takes it, as the treatment may be Maintenance of pharmacological effect: complex, intrusive and inconvenient many antihypertensive and oral hypoglycemic patients are prescribed very complicated agents. regimen of diet, exercise, and medication Maintenance of serum drug concentration including several pills a day. Such to control a particular disorder: e.g. complexity of treatment and factors like age, anticonvulsants. duration, depression, disabilities or psychosocial issues and life style Some diseases of public health modification directly or indirectly influences importance where non-adherence is a adherence to treatment. Behavioral changes major obstacle to achieving control: tuberculosis, HIV, and related and adherence to pharmacological treatment 1 are essential for improving the prognosis of opportunistic infections . diabetes mellitus2-4. The majority of adherence research Adherence has been carried out by healthcare providers As far as adherence is concerned, the and by the pharmaceutical industry, and has term implies passive submission of the patient focused on patient determinants of non- to the prescriber’s authority and obeys adherence rather than on shared treatment regimens. Adherence Implies the responsibilities of the doctor and patient. self-initiated choice of the patient to closely The first three decades of compliance follow a treatment plans. The prescribers have research from 1970 to 2000 have yielded to monitor the patient’s adherence to the medication, usage instruction so that they are little information to improve medication 1 adherence1. The reasons for this inadequacy benefited from the therapy . include the lack of a gold standard to AJADD[1][3][2013]238-250 Inamdar et al___________________________________________________ISSN 2321-547X Even after careful diagnosis and concern depending on the patient beliefs about given to improve the patient’s quality of life, the need for and efficacy of a particular the patient often deviates from the medication1. instructions. Patient who are adherent in one Medication adherence and non- situation may not so be in another. Stimuli adherence is the result of a complex that have positive influences on one interaction among many factors. Some individual may have a negative influence on of these factors are seen to improve another. Non-adherence may have many medication adherence and some factors different manifestations none of which are may negatively influence the medication mutually exclusive1,2. adherence of a patient. The situation is The extent of non-adherence in the almost unique to each patient and this is general population in the out patient setting one of the reasons why it is so difficult estimated that as many as 50 percent of to predict medication adherence1. prescriptions fail to produce desired results because of improper use and 14-21 percent of Factors Influencing Adherence patient’s never even fill their original The factors, which may influence prescriptions. It has been noted that adherence adherence, or for that matter any health tends to decrease with time, and prospective related behavior, can be divided into three long-term studies should ideally be categories: considered when evaluating therapeutic Predisposing factors include efficacy new drugs and its outcome1,2. demographic factors (age, gender, educational There are different situation in which achievements, socio-economic status, patient’s demonstrate medication Non- employment) also include the patient’s adherence. They have been categorized knowledge, attitudes, beliefs and perceptions whether the prescriptions was honored, about illness and its severity, cause, underused or overuse of the prescription prevention and treatment1. medication or use of non-prescription Enabling factors are the skills and medicines. Non-adherence has been further resources needed for adherence. the term categorized based on whether it was done on skills refers to the patients ability to adopt the patient’s own volition. It is possible that behaviors which will assist adherence and each condition and each doctor–patient resources includes the availability and involve different motivating factors, which accessibility of healthcare facilities such as affect adherence1,2,3. doctors, pharmacies, clinics or hospitals1. Reinforcing factors are those factors, Categorizing medication adherence which determine whether adherence is Adherent supported by family members, peers, Partially adherent healthcare providers, the local community, Non-adherent and society in general. The reinforcement Partially adherent is defined as may be positive or negative depending on the adherence to more than 70 percent of attitudes or behavior of significant people, the medication regimen, while some of whom will be more influential than complying with more than 80 percent of others. Reinforcing factors such as the prescribed regimen is termed as communication with the patient, the ability to adherent. Patient medication adherence resolve the patient’s concern regarding their may vary on a day-to-day basis, and disease and medication, regular follow up, may vary for different medications and quality and quantity of time spent with AJADD[1][3][2013]238-250 Inamdar et al___________________________________________________ISSN 2321-547X patient and family members, giving written Health belief model instructions to the patients may improve Knowledge
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