Voluntary Collaborative and Active Involvement of the Essay

Download this Essay in word format (.doc)

Note: Sample below may appear distorted but all corresponding word document files contain proper formatting

Excerpt from Essay:

voluntary, collaborative and active involvement of the patient in a course of behaviour that is mutually accepted in order to gain therapeutic result (Michael, H. et al., 2009). According to this definition it can be clearly observed that the patient has a clear choice to follow the goal and that the patient and well as the providers agree to make a medical regimen and treatment goals (Delamater, 2006).

There are two basic factors involved in the medical adherence, these are:

Whether the patients takes the medicine that has been prescribed to him/her.

Whether the patient keeps on taking the prescribed medicine or not.

Therefore, the adherence behaviour is divided into 2 main concepts which are: adherence and persistence. Although the concept of adherence and persistence is similar however, adherence means the intensity with which the drug was taken during the duration of the therapy while, persistence means the overall duration of the drug therapy (Caetano et al., 2006). This paper presents a Literature review (evidence based) on Interventions to improve medication adherence in people with multiple chronic conditions (cardiovascular).

Prevalence of Medication Nonadherence

It is very common for the patients suffering from cardiovascular diseases to be nonadherent to the medication. Jackevicius et al. (2008) after being hospitalized for acute myocardial infarction found out that the cardiac medications weren't even filled by one fourth of the patients by day 7 of discharge. This makes up to approximately 24% of the patients (Jackevicius et al., 2008).

It was shown by another study that about 34% of the patients at least 1 medication with 3 months of the discharge from hospital while, 12% stopped all 3 medications (Ho et al., 2006). Apart from the early discharge period there also seem to be an increasing decline in the adherence to the medication when it comes to the cardio protective medications (eg, statins, ?-blockers).

It was found by Newby et al. (2006) that the self-report of patients for the consistent use of medication over a period of 6-12 months was very low. About three fourths (71%) of the patients reported the persistent use of aspirin, the continuous use of ?-blockers was reported by less than half of the patients (46%), 44% took the lipid-lowering agents while 21% took all three of the medication after being diagnosed with the coronary artery disease.

Another study was conducted which showed that the percentage of patients who were still taking the statin medication 2 years after being hospitalized for the acute coronary syndrome was 40% while, the patients who were taking the statins for the treatment of coronary artery disease the adherence was even lower (Jackevicius and Mamdani, 2002).

The nonadherence to the medication for other cardiovascular diseases vary greatly according to the population that is being studied as well as the particular medicines that are studied such as; the medication event monitor (MEMS) data was used by Vrijens et al. (2008) and the result that he got clearly showed that the people who were prescribed antihypertensive medications stopped taking them within 1 year of the time that it was initially prescribed. It was also found that on any particular day a patient won't take ?10% of the doses of medication that were scheduled (Vrijens et al., 2008).

In contrast to the findings of Vrijens et al. (2008), Bramley et al. (2006) found that from among the patients who were on monotherapy for hypertension, 75% of those patients were adherent to the medication, which meant that the ratio of their possessing the medication was from 80-100%.

The medication adherence in the heart failure patients also vary widely such as; it was reported in a study that the persistence rates 5 years after an index heart failure for renin-angiotensin inhibitors was 79% while it was 56% for spironolactone, 65% for ?-blockers and 83% for statins (Gislason et al., 2007). The rate of nonadherence was to a large extent lower based on pill counts in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) randomized, controlled trial of the heart patients with heart failure was conducted which showed that the percentage of patients who were taking less than 80% of the pills that were prescribed to them was 11% (Granger et al., 2005).

Interventions to Improve Medication Adherence

Up till now the results that have been achieved through the interventions conducted for the sake of medication adherence have been modest. Generally speaking, the multimodal intervention have been a lot more successful than the unimodal, the reason behind this is the fact that there are multiple factorial reasons for nonadherence (Haynes et al., 2008; Heneghan et al., 2006; Schroeder et al., 2004; McDonald et al., 2004; Kripalani et al., 2007; Petrilla et al., 2005).

In the unimodal interventions the ones that showed some sort of success were the ones that made use of the motivational strategies, reduced the number of daily doses of medications, educated patients, packaged medications into special containers such as; the pill boxes, provided care that was more convenient or involved feedback and monitoring (Michael, H. et al., 2009).

The most promising interventions have been the multimodal interventions which not only improved the adherence but the outcomes as well (Michael, H. et al., 2009). The stable outpatients that were diagnosed with heart failure were randomized clinically by Murray et al. (2001) to an intensive pharmacist-led intervention against usual care and an improvement of about 10.9% in adherence to the cardiovascular medications was found.

Although the opportunities to improve medication adherence through the observational studies has been highlighted but there are many hurdles towards implementing these interventions in the clinical practices such as; the successful interventions that took place before had included multiple components and most often than not these components have been heterogeneous therefore, implementing those components in the routine practices can be very difficult. The cost of implementing these procedures gets increased by the requirement f the staff or the clinical personnel to monitor the procedure. Also, presently, there aren't a lot of financial incentives available for the promotion of the medication adherence. Until and unless some of these problems are solved the implementation of these studies in the routine clinical practices is going to be very difficult (Michael, H. et al., 2009).

Patterns and Reasons for Medication Nonadherence

Most of the times the reasons for the poor medication adherence are multifactorial, these reasons can be intentional or unintentional. The intentional nonadherence is when a person deliberately deviates from the treatment plan; therefore, it is an active process (Lowry et al., 2005).

In unintentional nonadherence a person can careless or forget to take the medication and this is a passive process. Vrijens et al. (2008) referred to this as the execution of the prescribed regimen. There are six general patterns of execution based on the electronic monitoring data, these are:

(1) Close to perfect adherence;

(2) Taking almost all the doses with some irregularity in the timing;

(3) Occasionally miss a single day's dose

(4) Taking drug holidays 3-4 times a year

(5) Taking drug holidays each month and therefore, not taking a lot of medication doses

(6) Taking few or no doses at all (Urquhart et al., 1997).

There are 5 major groupings being made by the World Health Organization for medication nonadherence, these are: patient, therapy, health system -- related factors, socioeconomic and condition (World Health Organization, 2003).

Another important factor that needs to be kept in mind here is that although in most of the cases patients are the ones who are held responsible for the medication nonadherence however, the healthcare system factors can also play an important role when it comes to the patient's nonadherence to medications (Michael, H. et al., 2009).

It was found by Makaryus et al. (Makaryus and Friedman, 2005) that there are less than 50% of the patients who remember the names of all of their medications and even few who know the purpose of those medicines, this clearly suggests that the system factors can play an important role in the medication nonadherence by the patients after getting discharged from the hospital. This founding was supported by another study which suggested that the discharge counseling reduced the medication non-adherence (Jackevicius et al., 2008).

Some studies also suggest that the system-level factors for example the bureaucratic processes which are associated with insurance claims can also have an impact on the adherence (Michael, H. et al., 2009). Bokhour et al. (2006) conducted a qualitative study in which he found out that from among the hypertension-related visits to the hospitals which resulted in the uncontrolled blood pressure; one third of those patients weren't even asked by the care provider about the medication that they were taking. Therefore, there can be a lot of non-patient related factors that could lead to medication nonadherence.


Bokhour BG, Berlowitz DR, Long JA, Kressin NR. How do providers assess antihypertensive medication adherence in medical encounters? J. Gen Intern Med. 2006; 21: 577 -- 583.

Bramley TJ, Gerbino PP, Nightengale BS, Frech-Tamas…[continue]

Some Sources Used in Document:


Cite This Essay:

"Voluntary Collaborative And Active Involvement Of The" (2013, February 24) Retrieved October 21, 2016, from http://www.paperdue.com/essay/voluntary-collaborative-and-active-involvement-103808

"Voluntary Collaborative And Active Involvement Of The" 24 February 2013. Web.21 October. 2016. <http://www.paperdue.com/essay/voluntary-collaborative-and-active-involvement-103808>

"Voluntary Collaborative And Active Involvement Of The", 24 February 2013, Accessed.21 October. 2016, http://www.paperdue.com/essay/voluntary-collaborative-and-active-involvement-103808

Other Documents Pertaining To This Topic

  • Perceived Effect of Culture on

    This, he says, is a big challenge considering the fact that all team members along with the top management come from different cultural backgrounds. Polley and Ribbens (1998) in their pioneering research assert that team wellness has got to be tackled in order to create high performance teams. The challenges that need to be over come have been thoroughly researched. The most commonly found problems are: lack of commitment and

  • Current Issues in Marketing

    Marketing Identification and development of a rationale for a current issue in Marketing:- The extensive embracing of the marketing concept by organizations is a comparatively new one. Sans one or two exclusions, writing on marketing is just crossing the fifty-year mark. However, during these fifty years the manner in which we think regarding marketing and its practice is undergoing a sea change. Marketing has advanced from a basic focus on 'giving

  • Distinction and Need for Governance at All Three Levels Corporate...

    Corporate governance, IT Governance and Information Security Governance IS 8310 Governance, Risk Management and Compliance Governance is the process of empowering leaders to implement rules that are enforceable and amendable. For comprehensive understanding of the term' governance' it is essential to identify the leaders and the set of rules, and various positions that leaders govern. Corporate governance, IT Governance and Information Security Governance embraces a linkage with certain acquiescence system while

  • Role of an Advanced Practice

    In other words, physicians authorize the nurse practitioner to prescribe certain medications -- perhaps not all but those medications that are most often required by patients -- without getting approval from a physician. It saves time and is primarily designed to make the patient more comfortable, not just to hand additional authority to the nurse practitioner. Is prescriptive authority appropriate? This question, according to Patricia Berry, a faculty member at

  • Impact of School Culture on School Safety

    School Culture on School Safety Many studies have been done on safety in schools. Likewise, many studies have been done on the culture of various schools. Unfortunately, there has not been significant research on a link between the two. This is not to say that these kinds of studies have not been done, but rather that there has not been enough of them. Many of the studies that have been

  • Human Resources Management Maintaining a Competitive

    Human Resources Management - Maintaining a Competitive Edge in the Corporate Marketplace Change continues to reshape the workplace. Today's HR professional is called upon to help the organization retain its competitive edge in the marketplace. Along with representing the best interests of employees, HR professionals assume the role of strategic partner, administrative expert, and change agent. HR assumes a critical role in promoting the vision and shaping the focus of the

  • Challenge of Managing All Stakeholders in the Context of a Merger...

    Managing All Stakeholders in the Context of a Merger Process Review of the Relevant Literature Types of Mergers Identifying All Stakeholders in a Given Business Strategic Market Factors Driving Merger Activity Selection Process for Merger Candidates Summary, Conclusion, and Recommendations The Challenge of Managing All Stakeholders in the Context of a Merger Process Mergers and acquisitions became central features of organizational life in the last part of the 20th century, particularly as organizations seek to establish and

Read Full Essay
Copyright 2016 . All Rights Reserved