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Main Post Chronic diseases are considered physical or mental conditions that compromise a person’s physical and social function, health-related quality of life, and the economic sustainability of healthcare. Management of these conditions are fundamental to minimize impact, improve health outcomes, prevent further disability, and reduce healthcare costs (Fernandez-Lazaro et al., 2019). However, non-adherence is a substantial challenge faced by patients and providers in their management of chronic diseases. Medication adherence is the extent to which a patient’s behavior matches the prescribed medication regime, time, dosing, and interval of medication intake (Gast & Mathes, 2019). At least half of the chronic disease population take their medications as prescribed, making medication adherence a priority of public health and a major healthcare stressor. It is a widespread problem and is crucial for the success and safety of therapies. Medication non-adherence has a more direct impact on patient outcomes than the specific treatment itself as it affects quality and length of life, health outcomes, and overall healthcare costs. Likewise keeping up medication regime as prescribed is associated with improved patient outcome, quality of life and lowered healthcare cost and financial burden (Fernandez-Lazaro et al., 2019). Medication adherence is influenced by patient, health care team, therapy, disease condition, and socioeconomic-related factors making adherence complex as each patient possesses their own set of health beliefs, socio-economic difficulties, literacy and education background and other social determinants (SDH) that create barriers to adherence. People who are struggling with housing instability, food insecurity, and/or unemployment most likely do not have the necessary emotional and material resources to pay attention to their health and treatment regimen adequately. These SDH affects medication adherence vastly. Therefore, understanding the influence of SDH on medication adherence is important and tackling this major healthcare issue requires a patient-centered approach (Wilder, 2021). Within my work environment medication adherence is a major challenge that is seen daily and has a direct impact on the healthcare setting. From diabetic patients being admitted with diabetic ketoacidosis (DKA) due to lack of access to insulin, hypertensive crisis due to running out of antihypertensives to fluid overload in congested heart failure (CHF) due to not taking the recommended diuretics because “I pee too much,” as nurses we see these situations every day. This of course puts a constraint on the facility with the ER overflowing with patients needing bed space and staff left feeling overwhelmed. The goal over the past couple years which heightened with the pandemic is to help patients identify their unique barriers and provide education and resources to help them navigate and be more involved in their care. The shift to value-based care and reimbursement resulted in healthcare finding ways to help patients move upstream and out of the water all together. In this pursuit, my hospital has included in the admission documentation questions about medication adherence which triggers the social worker and case managers to have one and one conversations with patients who meet criteria. My hospital also provides medication coupons and discount cards, for example Eliquis and Coumadin coupons. For patients who underwent cardiac stenting, their P2y12 inhibitors such as Ticagrelor/Brilinta and Clopidogrel/Plavix must be picked up from their pharmacy and presented to staff with at least a 30-day supply before patient can be appropriately discharged. In addition, my hospital has partnered with Walgreens with medication delivery systems that allows medication to be delivered to patients’ room prior to being discharged. In conclusion, medication adherence is a common problem. Patients give many reasons for not taking medications as prescribed including cost, underinsured or lack of insurance, adverse effects, and perceived lack of effectiveness. These social determinants identified are important factors in the shared decision-making between healthcare providers and patients. As providers, we are tasked with finding innovation and resources that foster and promote improved medication adherence as this will ultimately improve the quality of life for the individual and reduce the associated health cost. References Fernandez-Lazaro, C., García-González, J. & Adams, D. et al. (2019). Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract 20 (132). https://doi.org/10.1186/s12875-019-1019-3Links to an external site. Gast, A. & Mathes, T. (2019). Medication adherence influencing factors- an (updated) overview of systematic reviews. Syst Rev 8 (112). https://doi.org/10.1186/s13643-019-1014-8Links to an external site. Wilder, M., Kulie, P. & Jensen, C. et al. (2021). The impact of social determinants of health on medication adherence: a systematic review and meta-analysis. J Gen Intern Med 36(5):1359-1370. doi: 10.1007/s11606-020-06447-0.
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