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Adhering to encourage adherence

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Aspart of my rotation in mental health, I had to do a case presentation. As acommon problem with many patients at the hospital I work at is poor adherenceand poor compliance, it made sense that this is what my presentation should beon.

TheWorld Health Organisation defines adherence as the extent to which the patientfollows medical instructions. When researching this topic for my presentation,I found that, over a year, around 50% of patients that are prescribed psychotropicmedication will discontinue and non-compliance/partial compliance withpsychotropics can vary between 24-90%. I further discovered that non compliantschizophrenics had a 10 fold higher mortality rate. But it is not only theimpact non-compliance has on patients; it is also extremely costly to the NHS(in 2007, it caused an estimated cost of £100 million).

Thereasons for poor adherence can be intentional, where the patient purposefullydecides not to follow their treatment regime even though they may have told theprescriber they will, and non intentional, where the patient wants to follow their treatment regimebut external factors get in the way. Such factors may be the patientforgetting, being unable to access their medication or simply running out.Other examples of poor adherence are patients that:

-      stop taking their medication due to things like beliefs they do not needthe medication anymore

-      have a lack of support from friends and family

-      are worried about the stigma of having a mental illness

-      are preoccupied with substance misuse

-      are concerned about dependency

-      experience side effects (the most common side effects withantipsychotics are EPSE’s, feeling sleepy, gaining weight and incompetence)

Asolution for non-adherence would be to involve patients in the decisions madeabout their treatment, which would help to get the patients’ perspective andunderstand their reasons for not wanting to comply with their medication.

Anothersolution to non-adherence, and the one that I focused more on for mypresentation, is improving medicine management. This is to avoid complexmedicines regimes and simplify them by using MR doses instead of multiple dailydoses. Patients’ adherence could also be assessed through methods such as dosetteboxes and alarms, and it should be ensured that the patient has easy access totheir repeat medication once they leave hospital.

Theinterventions that were made to the patients for my case study was to changetheir tablets to depot injections. Depot injections mean that an injection isgiven every 1 – 4 weeks (depending on the type of injection). However,pharmacists should be aware that changing to depot injections isn’t always theanswer. The patient would still need to attend their appointments for theirinjections once they are discharged from hospital and they would still need tocomply with their other medication for any other conditions. Therefore,patients are not the only ones that need to be compliant - pharmacists should alsoalways adhere to their role of encouraging adherence. 

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