Medication Adherence Assessment of Patients in a Cardiac Rehabilitation Clinic
Doucette D. Horizon Health Network, Moncton, NB
Background
Non-adherence to medication is a major public health issue linked to lost work time, wasted healthcare resources, emergency room visits, hospital admission and death. Adherence to medication regimens is uncommonly evaluated with a systematic process or validated tool by frontline clinicians.
Description
Twoshort validated questionnaireswere introduced to assess medication adherence in ambulatory patients with known cardiovascular disease or at high risk of experiencing cardiovascular events.
Action
Medication adherence was assessed on patients enrolled in a 12-week Cardiac Rehabilitation (CR) program. All patients were invited to complete the Adherence Estimator® (AE) tool. Those rated as medium or high risk for adherence problems were eligible for secondary assessment using the Drug Adherence Workup® (DRAW) tool. Individualized interventions were implemented at discretion of the responsible pharmacy team member. All assessments were recorded in the patient electronic health record as part of continuing care.
Evaluation
Over 12 months, 174CR clinic patients (52 females, 122 males) were assessed with these tools. At initial assessment by AE tool, 72 patients (41.4%) were deemed low risk, 60 (34.5%) medium risk and 42 (24.1%) high risk for non-adherence. Of patients who screened high or medium risk, secondary assessments (DRAW) identified their most frequent concerns as having too many medications and experiencing side effects. Use of these tools assisted in designing interventions to improve intentional or unintentional behaviours associated with a patient’s suboptimal medication-taking. Patient interviewsoften yielded instances where new drug therapy problems were identified such as complaints of new adverse effects not previously reported by the patient.
Implications
Brief screening with a validated scale found 58.6% of cardiac rehabilitation patients at high or medium risk for adherence problems with medications. Follow up assessment with a second validated scale in those patients facilitated development of individualized plans to target causes of non-adherence.