Guild MedsIndex Health Professionals

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Name of Presenter Name of Pharmacy Pharmacy
Contact Details
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Agenda

• What is MedsIndex?
• Definition Non Compliance vs. Adherence
• Types of Non Compliance
• Adherence Models
• Measuring Adherence
• Factors Affecting Adherence
• Strategies to Improve Adherence
• Role of MedsIndex and Case Study
• Questions?

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1. What Is

• MedsIndex is a tool developed by The Pharmacy
  Guild of Australia to assist patients to improve
  their medicines taking and thereby follow
  prescribers instructions.
• A MedsIndex Score is created from a computer
  software tool with input data from the patients
  pharmacy dispensary profile. It calculates how
  much medicine the prescriber intended the patient
  to take, compared to how much has been dispensed.
• A MedsIndex Score can be used by Health
  Professionals to establish strategies for a
  patient to improve compliance.

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What Is

• MedsIndex gives a score out of 100 and there are
  four bands which give patients a visual
  indication of their compliance

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What Is

• The MedsIndex report also creates a summary page
  with up to 6 medicines
• A visual graphic is also indicated
• The report on the right is indicative for a
  patient on 5 medicines with varying degrees of
  compliance

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2. Definitions Non-Compliance vs. Adherence

• Controversy and disagreement over use of terms
• Are the terms non-compliance and adherence
  interchangeable?
• NON COMPLIANCE implies
• Deviant behaviour
• Patient to blame
• Lack of willingness to listen to prescriber/
  doctor/ pharmacist orders
• Prescriber /Doctor has power for decision
  making
• Responsibility rests with patient
• Patient placed in subservient role
  

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Non-Compliance and Adherence (cont)

• Active involvement of patient and prescriber
  /doctor/ pharmacist
• Responsibility - EQUAL patient and prescriber
  /doctor/ pharmacist
• Collaborative partnership
• Decisions NEGOTIATED vs. DICTATED
• For the purpose of MedsIndex the term
  compliance and adherence are interchangeable

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3. Types of Non-Compliance

• Non-compliance has historically been categorised
  as
• ERRATIC
• UNWITTING
• INTENTIONAL

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a. Erratic Non-Compliance Most Common

• Requirement of treatment is understood and agreed
  by the patient, yet not followed
• Reasons offered
• too busy
• too complex
• forgetfulness
• schedule changes
• psychological distress
• running out of medicines

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b. Unwitting Non-Compliance

• Prescriber Doctor/Pharmacist and patient believe
  patient is complying appropriately
• Commonly resulting from
• poor understanding of regimen
• incorrect administration technique
• language barriers
• cognitive impairment

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c. Intentional Non-Compliance

• Clear decision made to alter/cease treatment due
  to
• feeling better
• believe medicine not required
• believe regimen ineffective
• regimen too complex
• fear of addiction, side effects, toxicity
• medicines too expensive

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Types of Non Compliance Key Messages
A Health Professional looks for indications to
identify which category type a patient may fit
into, so underlying reasons for non compliance
can be addressed. A MedsIndex Score is an ideal
tool to assist this process
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4. Adherence Models Key Messages

• Every patient is different. Prescriber need to
  develop adherence models to aid development of
  strategies to improve compliance with medicines
• Behavioural change in terms of medicine taking is
  a process, not a one off event and takes time to
  achieve
• Attitudes and health beliefs can be influenced by
  health professional staff

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5. Measuring Adherence

• Methods of measuring adherence are divided into
  two groups
• DIRECT
• INDIRECT

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a. Direct Measurement

• Biochemical confirms drug ingestion levels (not
  practical in the Primary Health Care setting)
• Direct observation monitoring/observation of
  drug ingestion (Some methods not practical)

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b. Indirect Measurement used by Health
Professionals

• Clinician judgment impression/observation
• Self report patient interviews, diaries,
  questionnaires
• Medication measurement counting pills/dosage
  units each visit
• Pharmacy Dispensary database amount of
  medications dispensed
• Microelectronic measurement e.g. MEMS bottle
  cap applied to packing records time/date each
  use very expensive
• MedsIndex- technically an indirect measurement

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Adherence Measurement Key Messages

• Measuring adherence is a tool to help aid the
  Prescriber/ Pharmacist/Doctor in assessing a
  patients level of adherence
• Measuring adherence allows an intervention
  point to discuss issues with patients
• There are some shortcomings associated with
  direct and indirect measures
• It is essential to have an honest working
  relationship between patient and prescriber

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6. Factors Affecting Adherence

• Factors affecting adherence can be identified
  under three categories
• EXTERNAL
• PHYSICAL
• PSYCHOLOGICAL

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a. External Factors (affecting adherence)

• Mistrust of medical staff
• Treatment complexity set by prescriber
• Cost/socioeconomics
• Misinformation
• Lack of transport
• Social isolation
• Type of treatment can burden disease

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b. Physical Factors ( affecting adherence)

• Pregnancy
• Physical disability
• Obesity
• Side effects of medicines

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c. Psychological Factors (affecting adherence)

• Cognitive impairment
• Depression/anxiety disorders
• Unrealistic expectations
• Denial
• Rebellion
• Poor motivation
• Doubt skeptical about effectiveness of regimen

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Factors Affecting Adherence Key Messages

• Recognition of barriers to adherence patients
  need to be encouraged to speak to prescriber.
  Through this project Pharmacists will have an
  increased awareness of this issue.
• MedsIndex enables the development of problem
  solving strategies that can be planned in
  collaboration with the patient
• The reason for this new program is to identify
  exactly what is preventing improvement compliance

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7. Strategies to Improve Adherence

• EDUCATIONAL
• COMMUNICATION
• BEHAVIOURAL

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a. Education Strategies (to improve adherence)

• Knowledge Empowerment When a
  patient merely becomes aware that a compliance
  score is being undertaken compliance improves
• Patients want clear information/explanation
  
  The MedsIndex score out of 100 is simple to
  understand
• Chronic illness education is ongoing
• Better medicines compliance reduces risk of
  disease state complications and also reduces
  health costs)
• Medicines Packed
  
  Dose Administration Aid assists with increased
  compliance
• Medicines Profile
  
  A new pharmacy service that explains
  reason for each
• Use verbal and written tools
  
  Consumer Medicines Information -CMIs

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b. Communication Strategies (to improve adherence)

• Explain to patient how MedsIndex works and look
  for gradual improvement (take home report for
  patient)
• Provide information in an interactive manner
  build rapport
• Prescribers are advised to speak slowly and to
  ensure no medical jargon is used
• Encourage patients to ask questions and to seek
  information

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Communications Strategies (cont)

• Clarify patients understanding by asking them to
  repeat back key discussion points
• Use interpreter service if needed (contact
  Pharmacy Guild)
• Encourage questions
• Listen
• Ask patient to go back to pharmacy for updated
  report and thus wee how they are going (repeat
  MedsIndex in 6 months)

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c. Behavioural Strategies (to improve adherence)

• Written Report (MedsIndex)
• Cueing/reminders (Dose Administration Aids,
  Medication Profile)
• Positive reinforcement
• Therapy tailoring explore patients beliefs,
  simplify regimen, alter drug type/route in
  consultation with other health professionals

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b. Behavioural Strategies (cont)

• Pharmacists will refer Prescriber if appropriate
• Realistic attitude chronic disease will
  difficult for patients - learn to take the good
  with the bad and to set realistic goals
• Connection to pharmacy support team
• Patient satisfaction Adherence

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Can Help

• Compliance has never had a strong platform of
  measurement MedsIndex will change that
• Support programs have never had appropriate
  trigger points from which a pharmacists/ health
  professionals can refer
• Guild MedsIndex is an innovative, yet simple
  concept able to be understood by all patients

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Case Study

• Mr Stanley Smith has been prescribed Seretide
  Accuhaler 250/50 micrograms to be taken once
  daily and has 5 repeats scripts.
• Dispense History
• Seretide Accuhaler 250 microgram 60 doses twice
  a day
• 5 Repeats written 1 November 2007. Dispensing as
  per dates below
• 5/0 - 3 November 2007
• 5/1 - 18 December 2007
• 5/2 - 21 January 2008
• 5/3 - 28 February 2008
• 5/4 - 29 March 2008

Now lets calculate the MedsIndex Score using the
calculators?
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Calculation Tool
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Patient Score

• Mr Stanley Smith has an overall score of 75
• His medicines compliance has now been converted
  into a tangible number to help him understand how
  well he is going with the treatment plan
• The score allows the pharmacist to recommend
  medicines management programs where necessary,
  such as
• Initiate Medicines Profile
• Initiate Dose Administration Aid
• Recommend HMR

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Key Messages

• MedsIndex will assist with medicines compliance
  to achieve the best health outcomes for the
  patient
• There is no such thing as a good or bad score
  the focus is on improving the score and health
  professionals should be encouraging patients
• Remind patients
• Taking medicines correctly today and adhering to
  a treatment plan will avoid health problems
  tomorrow

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Questions ?