Magazine article Drug Topics

Improving Medication Compliance: A Key to Good Mental Health

Magazine article Drug Topics

Improving Medication Compliance: A Key to Good Mental Health

Article excerpt

Leigh Anne Brown, Pharm.D.

Assistant Professor

St. Louis College of Pharmacy

Gary M. Levin, Pharm.D., BCCP

Associate Professor

Albany College of Pharmacy and Medical Staff Associate

Capital District Psychiatric Center

There are three major barriers to compliance that have been identified. They are regimen complexity, poor communication, and unresolved concerns.

It's no secret that compliance with medication regimens decreases as the number of medications or the number of total daily doses increases. One study, for instance, found compliance with antihypertensive medications to increase from 59% with three-times-a-day dosing to 84% with once-a-day dosing.

One way of reducing medication noncompliance is to simplify drug regimens. This can be done by making sure the patient is prescribed the appropriate dosing interval; utilizing long-acting oral, transdermal, and injectable dosage formulations when possible; and discontinuing any unnecessary medication.

The newer atypical antipsychotic drugs are dosed once or twice daily. When a patient is stabilized on a conventional antipsychotic agent, the entire daily dose can be given at bedtime. Fluphenazine (Prolixin, Apothecon) and haloperidol are available in a long-acting decanoate formulation given once every two or four weeks, respectively. Most antidepressants are dosed once daily. Some others, such as bupropion (Wellbutrin, Glaxo Wellcome) and venlafaxine (Effexor, WyethAyerst), were recently introduced in sustained-release formulations. Pharmacists can reduce noncompliance due to regimen complexity by recommending practical dosing strategies and products.

Explain it clearly

Poor communication between the patient and health professional can also lead to medication noncompliance. Pharmacists may not always engage in face-to-face conversations with the patient, and, when they do so, they are frequently interrupted. Many times the information provided by the pharmacist may not be understood by the patient, especially when medical terms are used instead of more simple, nonprofessional language.

More commonly, the patient is just not given the information that is needed. Either the pharmacistclinician feels too busy to talk with the patient, or the patient feels too uncomfortable asking questions of the pharmacist-clinician. Additionally, it is estimated that, regardless of a patient's age, only 40%-60% of the information discussed during a medical visit can be recalled after the patient leaves the appointment.

Pharmacists are in an excellent position to counsel patients on their medications to reduce noncompliance due to miscommunication.

Resolve other concerns

If patients do not have a clear understanding of their disease or their medication, it's not likely they will comply with their treatment regimens. An asymptomatic disease state is also a disincentive for medication compliance.

A drug that provides an immediate effect on symptoms, as compared with a drug that has a delayed therapeutic action, will increase a patient's willingness to adhere to medication treatment. Examples of psychiatric drugs with a delayed effect are antidepressants and antipsychotics, as compared with drugs that have an immediate psychotropic effect, such as benzodiazepines.

Additionally, if patients lack faith or trust in the beneficial effects of their medication or fear side effects, they are less likely to comply with treatment.

An interactive patient education/ counseling session can result in the discovery and resolution of many of these concerns that can lead to medication noncompliance.

Detecting noncompliance

Several methods can be used to measure medication compliance. Each of these methods has both advantages and weaknesses. It is often necessary to use a combination of methods to more accurately estimate compliance. Indirect methods of assessing compliance are most commonly reported in the literature because of the ease of obtaining these measurements. …

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