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03/20/2014

All Grown Up - Medication Adherence in Adults

As individuals grow older, the more likely they are to depend on medications to manage a disease state or to even extend their life. Therefore, in order for a medication regimen to be successful in treating a patient, it is important to stress the value of medication adherence. The adult population (ages 19-64) takes many medications on a regular basis, either for acute or chronic diseases. To improve adherence in adults, barriers such as cost, health literacy, and pill burden should be addressed.

Barriers: Prescription medication can be very expensive and therefore may play a role in adult patients’ adherence levels, even if they are not in good health. Cost influence on the patient can be verified by questions such as whether patients got their prescriptions filled, used herbal medications rather than prescription medications, or even stretched out the time till next refill. During a study, it was seen that when there is a cost barrier to medication adherence, adults tend to have a low income status, no drug coverage, or have multiple disease states. Therefore, different programs can be used to assist patients in decreasing medication expenses and thus improve adherence.

Besides cost, health literacy is also a barrier that prevents adults from reaching optimal medication adherence. Most adults will have to manage certain illnesses for the rest of their lives and thus it is important for them to have the necessary disease knowledge. Presentation about the medication include the purpose, mechanism of action, and other drug benefits which may lead patients to have increased medication adherence because they are expecting better health outcomes.

Additionally, many adults have multiple diseases to manage, which results in difficulty to many medications rather than just one. It is during this age that adults are newly diagnosed with chronic diseases such as diabetes, asthma, and hypertension. Therefore issues such as pill burden can be problematic when there are comorbidities involved. Patients may feel overwhelmed if they have to take multiple medications for diabetes, then asthma and also manage another serious condition of HIV. Options of combination medication therapy should be considered to decrease pill burden.

Asthma: The disease of asthma requires abundant counseling in order for patients to receive optimal therapy and avoid complications. With many inhaler options for both rescue and maintenance therapy in avoiding asthma exacerbations, it can become real confusing for patients to manage. When asthma is not appropriately managed it can lead to increased hospital visits and unwanted health expenses. Recent studies have concluded that patients with increased knowledge, attitude and self-efficacy in managing asthma can improve adherence. This is a disease state that, if patients understand signs and symptoms of asthma and use personal skills in managing the complications, it will result in a better quality of life. It is important to review both disease state and therapy schedule with adult patients every time they receive an inhaler, so patients can be in charge of their own health.

Pharmacists are constantly dispensing medications to adults and thus they have the perfect opportunity to help adults overcome barriers such as cost, health literacy and pill burden. Adulthood is a time in life where patients have to take care of their own health, income, and knowledge. Although adults are independent, pharmacists can step in to provide cost effective solutions and information about managing chronic illnesses such as inhaler techniques for managing asthma exacerbations. Pharmacists can use their knowledge about medications, cost coverage and managing disease states, in order to help adults improve medication adherence.

Sheenu Joseph, PharmD '15

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