Drug Compliance and Antibiotic Resistance

1. Drug Compliance and Antibiotic Resistance Joshua Fiore Amanda Thorne

2. Overview • I. What is drug compliance? • II. Why is drug compliance important? • III. What are factors that lead to non-compliance • IV. How can we encourage patient compliance? • V. How patient compliance can affect healthcare. • VI. What is antibiotic drug resistance? • VII. What are the causes? • VIII. Effect of drug resistance on patients and healthcare • IX. How can we reduce the occurrence of antibiotic resistance • X. Post Quiz

3. Medicine • Medicine has been developed over the years to help treat sick patients, and to help prevent future illnesses. • Medicine is so advanced today; that it’s to the point where people are required to take multiple medications, hourly, everyday. • Not only is there a lot of medications out there, but there are also a lot of people prescribing medicines. • For example dentists, doctors, psychologists, and more can all prescribe prescription drugs. • In order for medication to be effective, patients must comply with the prescribers requests.

4. Medication Compliance/Adherence • Medication compliance is “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result”(Ho, medication adherence). • What this really means is patients make a choice to follow certain medication routines to achieve results. • Medication compliance isn’t just on the patients. • Medical professionals must show the ethics expected of them. • This means not giving out too big of prescriptions, filling out prescriptions to satisfy patients, giving the patients the wrong medications, giving out medications without a prescription, and in some cases stealing the medication.

5. Importance • If patients don’t comply with taking medication it can lead to higher health care costs. • If a patient takes their medication properly it will lead to higher pharmacy costs, but it will reduce medical costs. • A patient who doesn’t take their medication saves money on medication, but will most likely end up back in the hospital creating higher medical costs. It is estimated that  290 billion dollars is spent in emergency-room visits a year, due to non adherence of medications. • Not only does it cost the patient money but it costs the economy money. The economic impact of non-adherence is estimated to cost $100 billion annually(e-pill.com)

6. Patient Health • Medications have been created to help treat illnesses and support recovery. • Patients who take their medications recover better and extend their life span. • A patient that does not follow the medication plan will not get the proper results. • Following a medication plan does not mean taking the medication until you feel better. It also doesn’t mean taking more than you need.

7. Factors Contributing to Non-Compliance • Forgetfulness • Side-effects • Poor relationship with physician • Patient feels no need. • Cost of medicine • Lack of family/social support • Patients who don’t care about getting better

8. Forgetfulness • Forgetting to take medication is one of the biggest problems in medication non-compliance. • Patients taking multiple pills a day multiple times a day are the biggest offenders. • Where “32 million Americans use three or more medicines daily” (e-pill), there’s an obvious problem.

9. Lack of Support • Lack of family or social support is often associated with older people. • Elderly people who live by themselves, with health problems are challenged with taking their medication with no reminders. • If a patient has not been on medication for a long time it is a hard transition to make. • This can also be tied into patients not caring about getting better.

10. Patient Negligence • Patients who don’t care about getting better fall into this category • Elderly people living alone with little support may be negligent. Since there is no one there for them they may see no point in getting better. • Some patients could like the attention they get from being sick. Therefore not taking their medication would prolong the attention they receive.

11. No Need. • Patients who think medication does nothing for them will often feel no need to take their medication. • Patients who think medication costs too much will often feel no need to take their medication. • This problem can be fixed with a better relation ship between the patient and their physician.

12. Encouraging Patient Compliance • Getting patients on the same page as prescribers is an important task with patient compliance. • Patients need to be educated on the seriousness of not taking their medication properly • Patients need to know that the medication they are taking is actually going to make a significant change in their recovery.

13. Physicians and pharmacist need to educate the patients on their medication regardless if they ask or not. • Too often patients go home and google their medication. • It’s a good way to know what the medication does but the internet also can scare patients.

14. If a patient reads how bad the medication is, or that it didn’t work for a certain person then the patient will get the wrong impression of the drug. • Physicians need to let their patients know that “Studies have shown that non-compliance causes 125,000 deaths annually in the US” (e-pill). Also that it leads to 10-25 percent of hospital or nursing home admissions(e-pill). Patients need to know that not taking medication is a bigger risk than taking it.

15. Fixing problems • The first step in better patient compliance starts at the pharmacist • The pharmacist plays an important role in deciding what medications a patient can take. • Since a pharmacist knows everything about medications they can let physicians know all the different drugs available.

16. Pharmacist provide face to face interaction with patients. • Patients can learn everything about the drugs they are taking. This will help clear up misinterpretation of the drugs. • Properly educating patients will lead to patients feeling more comfortable with taking their medication.

17. Prescribers and patients need to have communication for adherence to advance. • The patient needs to be included in the decision making process of which medication best suits them. • Keeping patient records can help with the process. Noting that patients don’t like taking certain medication can prevent a health care provider in prescribing the wrong medication.

18. Having check up frequently with patients can help keep them on track. • Informing patients of the better outcomes can help them stay on track. • A good way to help patients would be filling out a calendar with all the specific times they need to take a pill. Being physically reminded everyday can help turn medication into a second nature.

19. Something as simple as the label or packaging of a drug will create non-adherence. Studies have shown that changing the package of medication leads to greater adherence. • Changing doses is another method at creating better adherence. If a patients dosage is upped, where they have to take the pill less, then it is more likely the take the ill.

20. Healthcare • Non-compliance with medications has been called the nations other drug problem. • It causes medical professionals to focus on creating compliance rather than medical problems. • With better patient compliance healthcare can move forward instead of staying at a stand still.

21. Why is this relevant to me?

22. Antibiotic Resistant Bacteria • 2 million infected in the United States per year • 90,000 die from the infection • Of hosptial-aquired bacteria, more that 70% are resistant to at least one antibiotic • U.S. Department of Health and Human Services 2006

23. Penicillin,Macrolide, B-LactamaseResistance for S. Pneumoniae and H. Influenzae

24. What leads to antibiotic resistance? • Non-compliance with antibiotics • “therapeutic incompliance leads to storing of antibiotics at home, which induces self-medication and produces a vicious circle, thereby favoring the emergence of bacterial resistances” - Journal of Antimicrobial Chemotherapy . • Over prescription of antibiotics • Use of antibiotics in livestock

26. Effects on Patients and Healthcare • Longer treatment time • Requires multiple antibiotic treatment • Increased side effects/toxicity • Increased cost • Increased mortality rate • Decreased quality of life

27. How can we fix it? • Develop new antibiotics • Not as cost effective for pharmaceutical companies • Increased patient compliance teaching • Use antibiotics more sparingly • Reduce the amount of antibiotics used in food processing • Hand washing

28. Who should be held accountable?

29. Work Cited • "Medicine Adherence:Involving Patients in Decisions About Prescribed Medicines and Supporting Adherence. ROYAL COLLEGE OF GENERAL PRACTITIONERS, Jan. 2009. Web. 30 Sept. 2012. • Ho, Michael. "Medication Adherence : Its Importance in Cardiovascular Outcomes." American Heart Association, 2009. Web. 30 Sept. 2012 • Nana, Giga. "Patient ComplianceMedicationAdherenceMedication Non-AdherenceStatistics & References." Patient Compliance Medication Adherence STATISTICS. E-pill, n.d. Web. 08 Oct. 2012.. <http://www.epill.com/statistics.html>. • Lehne, Richard A.. Pharmacology for nursing care. 6th ed. St. Louis, Mo.: Saunders Elsevier, 2007. Print. • Llor, Carl, Nuria Sierra, Silvia Hernandez, Ana Moragas, Marta Hernandez, Carolina Bayona, and Marc Miravitlles. "The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance." Journal of Antimicrobial Chemotherapy 62.2 (2009): 396-399. Oxford Journals. Web. 25 Sept. 2012. • "The Problem of Antimicrobial Resistance." Exploring. U.S. Department of Health and Human Services, n.d. Web. 3 Oct. 2012. <www.idph.state.ia.us/adper/common/pdf/abx/tab9_niaid_resistance.pdf>. • Thomas, JK, A Forrest, SM Bhavnani, JM Hyatt, A Cheng, CH Ballow, and JJ Schentag. "Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy.." Antimicrobial Agents And Chemotherapy 42.3 (1998): 521-527. Print.

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