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Pharm 5018

ch 6 Factors That Foster + Outcome

Intentional vs. Nonintentional Prescribers must evaluate whether not taking the drugs was a willful act/Does the person have dementia?/Do they believe that the medication was discontinued or replaced?/Did they not understand it was to be continued for a longer period of time?/Did they not understand that a “cure” was not reasonable?
Barriers to Adherence Perceived adverse drug reactions /Asymptomatic conditions/Chronic conditions/Knowledge deficit/Cognitive impairment and psychiatric illness
Barriers to Adherence Complexity of drug regimen/Financial impact of medications/Communication difficulties/Multiple providers
Measuring Adherence There is not one method that is foolproof/Patient reports/Communicate with patient!/Clinical outcomes/Pill counts/Refill records/Biological and chemical markers/Example: laboratory tests or vital statistics (such as blood pressure) not improved
Keys to Patient Education Simple instructions/Written handouts at appropriate literacy level /Instructions in native language, both oral and written/Incorporate aids, such as colored bottles and calendars/Incorporate health and cultural beliefs.
Involve the Patient With the Plan Patient-centered care means discussing the perceived barriers to care and possible solutions to the problem/Have a clinic navigator or clinic staff call the patient and ask how he or she is doing/Set goals and also reinforcements for keeping to the plan.
Simple Solutions? Make plan less complex/Provide home delivery of medications. Do not let patients leave without scheduled follow-ups./Can the plan be more flexible?
Conduct a Review of the Nursing Database to Find Unknown Barriers See Figure 6-1 for the Five Spheres of Influence and the many possible factors that may be at the crux of the problem /Previous stability or adherence that becomes unstable is typically related to a change in one or more of these variables
Domino Effects Change in one sphere of influence can trigger changes in another. Example: loss of insurance (health system influence) can trigger issues of cost (socio-economic sphere), create family stress (interpersonal sphere), decrease feelings of personal worth (personal sphere), etc
Try to Find a Factor That Can Be Modified Seek resources for new insurance/provide access to low-cost medication programs. /Send messages that you care./Make referrals as needed for social care
Created by: palmerag



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