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KEPATUHAN PASIEN
OUTLINE
PENDAHULUAN
LIMA DIMENSI KEPATUHAN BY WHO
MENGUKUR KEPATUHAN
FAKTOR YANG DAPAT MENYEBABKAN
KETIDAKPATUHAN
INTERVENSI
PERAN FARMASIS
Drugs dont work in patients who dont take them.
C. Everett Koop, M.D
PENDAHULUAN
Adherence to (or compliance with) a medication regimen is
generally defined as the extent to which patients take
medications as prescribed by their health care providers.
Adherence rates are typically higher among patients with
acute conditions, as compared with those with chronic
conditions; persistence among patients with chronic
conditions is disappointingly low, dropping most
dramatically after the first six months of therapy
PENDAHULUAN
Poor adherence to medication regimens accounts for substantial
worsening of disease, death, and increased health care costs in
the United States
Studies have shown that medication misuse is a significant cause
of hospital readmissions and can be prevented in nearly two-
thirds of all cases. Patients on complex drug regimens taking
multiple prescriptions are at high risk for non-adherence
Chronic diseases account for 70% of all deaths and are the
leading cause of morbidity and mortality in the United
States.
3
Approximately 20% to 50% of patients are nonadherent
to their medications.
Global Medication Adherence is 50%
WHOs Five Dimensions of Adherence
1. Social & Economic
Community Support
Economic
2. Health Care System
Provider-Patient Relationship
2. Health Care System
Using two-way communications and asking open
ended questions fosters encouragement.
Shared Decision Making
3. Condition Related
Chronic conditions, such as hypertension, that
lack symptoms highly impact the level of
adherence.
Peoples belief about the benefits and risks of
medications influence whether they abide by a
regimen.
4. Therapy Related
Therapy-related factors include the complexity of medication
regimen and unpleasant side effects.
Dosing several times a day may contribute to non-adherence
Adherence rates for once a day medication averaged 87%; twice daily
averaged 81%; three times per day averaged 77%; while adherence to
medications that required four times per day dosing dropped to only 39%.
Evaluating the medication regimen and keeping it as simple as possible for
the patients will promote adherence.
Concern about medication side effects
5. Patient Related
Perception of need, medication effectiveness, and
safety.
Follow up Appointments
Personalized education and counseling sessions
delivered by telephone, intranet, or in person by
trained personnel.
MENGUKUR KEPATUHAN
Dapat dibagi menjadi 2 cara:
Langsung
Tidak Langsung
Salah satu metode langsung adalah dengan mengukur kadar
obat/metabolit dalam darah for some drugs,measuring these
levels is a good and commonly used means of assessing
adherence
Ex: serum concentration of antiepileptic drugs such as
phenytoin or valproic acid will probably re-flect adherence to
regimens with these medications, and subtherapeutic levels will
probably reflect poor adherence or suboptimal dose strengths
Setiap metode memiliki kelebihan dan kekurangan, dan tidak
ada gold standard.
FAKTOR YG DAPAT MENYEBABKAN
KURANGNYA KEPATUHAN
Common barriers to adherence are under the patients control,
so that attention to them is a necessary and important step in
improving adherence
Cause patients not taking their medications:
forgetfulness (30 percent)
Other priorities (16 percent)
Decision to omit doses (11 percent)
Lack of information (9 percent)
Emotional factors (7 percent)
27 percent of the respondents did not provide a reason for poor adherence to
a regimen
INTERVENSI
Methods improve adherence can be grouped into four
general categories:
Improving adherence combinations of behavioral
interventions and reinforcements in addition to increasing the
convenience of care, providing educational information about
the patients condition and the treatment, and other forms of
supervision or atten-tion
patient education
improved dosing schedules
increased hours when the clinic is open (including evening hours), and
therefore shorter wait times
improved communication
PERAN FARMASI
Many studies have been done to determine whether pharmacist
interventions can lead to improved adherence and treatment
outcomes. In a large meta-analysis conducted to determine
medication adherence (along with several other outcomes),
pharmacist interventions were found to improve medication
adherence
Pharmaciststhrough counseling, medication therapy
management (MTM), disease-state management, and other
meanscan play a pivotal role in patient care. There are
opportunities in every type of pharmacy practice to improve
patients adherence and therapeutic outcomes, and pharmacists
must embrace and act on them.
Patients unique Pharmacist must approach each patient
individually to determine the level of adherence and barrier
Education:
Helpful but not enough to persuade the patient to comply with the
physicians drug orders. Information clear, easy to understand language,
and the patient must understand not only the benefits of adherence, but the
repercussions of nonadherence.
Dosing simplification and minimization of adverse effects are
extremely successful strategies for improving adherence.
when filling a prescription review to see whether the dosing schedule is as
simple as possible. The pharmacist should inquire frequently about any
adverse effects the patient is experiencing and then consult the physician
regarding suggested alternatives.
Preparing a dosing card containing only the most essential elements of the
patients medications can be highly beneficial.
Including the name of the pill, an image (if possible), the condition it is for, and time of
day taken can be extremely helpful for patients who take many medications or who have
cognitive barriers.
Reminder calls, texts, or e-mails are helpful for many patients, especially
those with busy lifestyles. Automatic refills are a useful strategy. Small
details, like splitting a patients pills when necessary and providing easy-off
caps, can be beneficial.
Whatever the barriers to adherence may be, the only way to assess them is to
talk to the patient. The pharmacist needs to be diligent about including the
patient in the treatment experience. The more trust the patient has in the
pharmacist, the more he or she will open up and disclose any apprehensions
or difficulties about taking his or her medication. Only then can the
pharmacist play an integral role in improving a patients adherence.
If not pharmacists, then who should lead adherence?
Pharmacists, as the medication experts should be leading the way to
ensuring optimal medication use
Pharmacists are in an excellent position to improve medication
adherence
Cochrane Collaborative:
Summary of Adherence Interventions
For long-term treatments, simplifying the dosage regimen
and several complex strategies, including combinations of
more thorough patient instructions and counseling,
reminders, close follow-up, supervised self-monitoring,
rewards for success, family therapy, couple- focused therapy,
psychological therapy, crisis intervention, and manual
telephone follow-up can improve adherence and treatment
outcomes. If there is a common thread to these at all, it is
more frequent interaction with patients with attention to
adherence.
TERIMA KASIH