ch 6 Factors That Foster + Outcome
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| 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?
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| Barriers to Adherence | Perceived adverse drug reactions /Asymptomatic conditions/Chronic conditions/Knowledge deficit/Cognitive impairment and psychiatric illness
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| Barriers to Adherence | Complexity of drug regimen/Financial impact of medications/Communication difficulties/Multiple providers
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| 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
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| 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.
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| 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.
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| 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?
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| 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
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| 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
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| 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
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