Done by Nada Saraeb Sponsored by AHEC / Community Health Scholars Directed by Dr. Kelli Wells

1. NON-COMPLIANCE with Medications • Done by Nada Saraeb • Sponsored by AHEC / Community Health Scholars • Directed by Dr. Kelli Wells

2. What is AHEC? • AHEC: Area Health Education Center • AHEC Mission: Enhancing access to quality health care (primary and preventive care) by improving the supply and distribution of health care professionals through community/academic educational partnerships • AHEC Goals: • Extend academic resources to medically underserved communities • Provide information and support for community health professionals • Influence the health professions education • Influence the future of health professional work force

3. Non-Compliance with Medication Use • Goals: • Reasons for non-compliance • Ways to help with non-compliance • Stages: • Create a survey about compliance with medication use • Interview patients • Collect results • Place: Escambia County • Escambia Community Clinic • Health and Hope Clinic • St. Joseph Clinic

4. Patients Interviewed • Total People Interviewed: 131 Patients • Uninsured Patients: 113 • Insured Patients: 18

5. Compliance • Escambia Community Clinic: 9 out of 55 • Health and Hope: 8 out of 41 • St. Joseph Clinic: 4 out of 15 • Insured People: 5 out of 18

6. Medication Use • Combination of reasons for non-compliance. • No obvious link between the race / age and non-compliance. • Link between non-compliance and patients educational needs, financial needs, medical condition, and severity of symptoms. • Higher compliance: • Pain • Discomfort • Anxiety • Depression • Restless leg syndrome • Insomnia • GI problems

7. Non-Compliance Reasons at ECC

8. Financial Needs

9. Financial Reasons • Self-adjusting • Last longer • Expensive • Can’t afford it • Run out of samples • Waiting for prescription assistance program • Not covered by charity programs (E.g.: Sacred Heart)

10. Educational Needs

11. Educational Reasons • Lack of knowledge about disease state: • Lack of communication with physician • Afraid to ask questions; doctor seemed in a hurry or busy • Hard medical terms used: Triglycerides - hypothyroidism • Lack of knowledge about long term complications • Short period appointments

12. Educational Reasons • Ignorance about life style changes • Patients need more information • Examples: • Some diabetic and hypertensive patients don’t know symptoms for hypo or hyper conditions • Don’t know what food to avoid • Don’t know what goals to achieve

13. Educational Reasons • Don’t know side effects • Mixed between side effects and complications • Hear about serious side effects from people around them • Experience serious side effects: • Hair loss • Sexual dysfunction • Suicidal thoughts

14. Educational Reasons • No enough knowledge about side effects

15. Educational Reasons • No signs and symptoms => no need for medications • Don’t believe they have the medical condition • Ignorance

16. Inconvenient Dosing

17. Other Reasons • Life circumstances • Busy life • Work • Out of house • Children • Stress • Specific circumstances • Too many meds • Forget which one have already been taken • Not organized • Obtaining refills • Run out of refills before seeing their doctors • Busy to obtain refills • Didn’t get new prescription for prescription assistance program

18. Random Findings • Lack of knowledge about disease state doesn’t always result in non-compliance • Patients prefer asking physicians more than pharmacists about their medications • Some pharmacists in busy pharmacies don’t give time to address patients’ concerns • People complained that there is a lack of communication with their physicians

19. Random Findings • A lot of patients were not sure if the physicians who they see communicate with each others • Most of the patients who claim to be non-compliant because of life circumstances or too many meds don’t use pill holders or chains • Some patients stop taking their medications because of serious side effects without asking their doctors first

20. Random Findings • Some patients have hard time reading instructions on medications’ labels (too small to read, illiterate…) • Patients charts not always complete with all medications they take • No available interpreters for patients who don’t speak English (not even a Spanish one!!!) • Some patients learned to use inhalers by themselves

21. Random Findings • Serious diseases in our community are not having the appropriate attention (Hepatitis C) • 2 out of 3 patients who I interviewed are not receiving treatment for hepatitis C • A lot of patients admitted that they don’t tell their physicians that they can’t afford their meds and never fill it too • A lot of patients don’t realize the importance of measuring their blood sugar • A lot of patients lack family support

22. Recommendations • Have a common Spanish speaking employee on call for the 3 clinics • Have the physician tell a little about the medication prescribing (side effects, what does it do, what goals to be achieved…) • Physicians make sure that patients can afford their meds • Physicians or nurses enforce having pill cases and pill holders key chains

23. Recommendations • Community health scholars programs are very important for students • Get pharmacy students to do their rotations at ECC • Counsel patients • Check for adverse reactions • Answer patients concerns • Have students get access to the system and have a print of the daily schedule sheet