Communicate with a patient with empathy & ethics on drug
usage—Tell about the
1. Effects of the drug-why, which symptoms disappear, when to
start & stop?
2. Adverse effects- what are they, how to recognise, how long, how
serious, what action to be taken?
3. Instructions on use-
How to take,when,how long,storage,what to do with left over
drug?
4. Warnings-
CI,Max.dose,why full Rx course is needed?
5.Future Consultations-
When to come back,when to come earlier,what info is needed at next
visit
6. Conclude the consultation-
Ask patient if he/she--understood or not,to repeat imp info,if there are
any queries
Communicating to the patients suffering from chronic diseases like
Hypertension, Diabetes mellitus, regarding
a) Usage of drugs
b) Medication Adherence
c) Consequences of Non-Adherence
d) Motivating adherence/ compliance (taking medications as per the
instructions given)
Medication adherence
• Def-Degree to which pts behaviour corresponds with agreed
recommendations from health care provider.
Medication adherence can be measured by several methods,
including
• (a) self-report questionnaires or structured interviews,
• (b) therapeutic drug monitoring (TDM),
• (c) electronic adherence monitoring (e.g. medication event
monitoring system), and
• (d) pick-up/refill rates
• Measurement of drugs and their active metabolites in
patients receiving medications for purpose of
optimizing their therapeutic effect while minimizing
adverse effects.
• Therapeutic range-min conc required for effective
therapy and maxi conc permissible, above which there
is potential for toxicity
• Wide Therapeutic range-drug is safe (CCB)
• Narrow Therapeutic range-Digoxin, theophylline, Li
EAM- electronic devices that record medication taking time,date
of each dose
Devices that remind pts –it is time to take medication
• Special watches with alarm
• Automated pill dispensor
• Blister pack –Report when each pill is removed
it is scanned by reader and data is uploaded in computer
• Refill rates- No. of pills taken calculated by substracting no.of pills remaining from
total no.of pills dispensed.
• Drug Adherance Rate= No. of pills taken /No. of days elapsed since last dispensed
Consequences of non-adherence:
• 1.Development of drug resistance
• 2.Incomplete cure
• 3.Disease-Carrier status
• 4.Loss of work hours & pay
• 5.Decreased QOL-Quality Of Life
Barriers affecting Medication Adherence...
• Fear
• Cost
• Doesn't understand the need for medicine
• time taken for the effects to be seen
• too many medications
• lack of relief of symptoms
• Mistrust
• worry, depression etc
Strategies to motivate a patient to adhere
Understand each patient medication-taking behaviour
Talk about the side-effects
Collaborate with patients
Consider the financial burden to the patient
Assess health literacy
Reduce complexity
Follow up with patients
HEALTH LITERACY
• Degree to which individuals have ability to find ,understand ,use inf &
services to inform health related decisions & actions for themselves
and others
Communicate with a patient with chronic Disease
• Explain the term “Medication Adherence”
• Explain the consequences of “Non-Adherence”
• Explain the methods to measure the medication
adherence
• Elicit the barriers affecting medication adherence
• Explains the measures to be taken to motivate the patient
to adhere
• WHO describes Pharmaceutical promotion as all information &
persuasive activities by manufacturers & distributors , the effect of
which is to include prescription ,supply ,purchase or use of medicinal
drugs
Communicate with a pharmaceutical
Representative
• Generic Name, Brand Name
•Content of “Active Ingredients” ,name of other ingredients
known to cause problems, any dependence?
• Approved therapeutic uses
• Dosage form or regimen
•Major adverse drug reactions; precautions, contra-
indications and warnings; major interactions
•Name and address of manufacturer or distributor;
•Reference to scientific literature as appropriate.
• Place of communication-peaceful ,undistracting environment
• Time allotted – ½ hr
• Attitude of prescriber- polite ,respectful
• Never be greedy
