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Timothy E. Gibbs, BA, NPMc Executive Director, Delaware Academy of Medicine Objectives At completion of this presentation the audience will understand: 1. The importance of drug regime compliance 2. How adherence and compliance are similar, yet different 3. Identifying barriers to, and negotiating adherence with patients needing medication. 4. How non-compliance is similar to drug “abuse” An estimated 50% of all patients do not take medications properly: •Right dose, •Right time, •Right conditions When patients are asymptomatic . . . Non-compliance rates increase dramatically to an estimated 75% percent. Providers tend to OVERESTIMATE medication compliance Compliance and Adherence Similar meanings, but different connotation: “Comply” means something like “Do what I tell you” “Adhere” means something like “Stick to the plan” The word “Compliance” defines •A power dynamic between provider and patient •Patient has less control •Patient has greater opportunity to “fail” When patients fail to COMPLY— Blame is placed on the patient rather than the provider. Barriers to Adherence •Economic •Social •Behavioral •Environmental •Cultural •Biological Barriers to Compliance: Confusing and conflicting drug regimes may be a substantial barrier. Recognizing Another Barrier Healthcare Provider-Patient Relationship Must be based on mutual respect and trust . . . Adherence is Improved if a Patient: • Takes part in negotiating the treatment plan • Understands the disease and treatments • “Buys into” or believes in the treatment plan When patients believe in the Treatment Plan •They adhere to the medication regime AND •They seek out support for lifestyle changes, like •DIET •EXERCISE Providers Need to LISTEN to and ADDRESS patients’: •Fears •Lifestyle concerns •Social and family issues TEACH patients about: •Disease process •Medication side effects Opportunities to reduce barriers •Health education •provider/patient relationship and negotiating •Better protocols with fewer side effects •Cues to non-adherence How does Medication Non-Adherence compare to Drug Abuse? •Failing to take medications as prescribed • Taking medications NOT prescribed •Not seen as an ethical breach •Seen as an ethical breach •Poor health outcomes •Poor health outcomes •Financial costs to families and society •Financial costs to family and society Non-Adherence Drug Abuse Legal Concerns If it’s illegal to consume an illicit drug, should it also be illegal to FAIL to take a prescribed drug? What about Immunizations? TB programs? Forced quarantine? Further Research is Needed To bridge the gap between what it means to take a drug to feel good, versus taking a drug to be well. Conclusion/Questions