Medications non-adherence

The clinician must identify potential reversible causes of heart failure exacerbations including prescription and nonprescription drug therapies, dietary indiscretions, and medication non-adherence. 

Hughes CM (2004) Medication non-adherence in the elderly how big is the problem Drugs Aging 21 793-811... 

The elderly are particularly susceptible to interactions because of the changes in physiology, multiple physician prescribing, increased use of OTC medications, non-adherence to complex regimens, and multiple disease states that complicate the handling of medications. 

Tajouri TH, Driver SF, Holmes DR Jr (2014) Take as directed - strategies to improve adherence to cardiac medication. Nat Rev Cardiol 11 304-307 Teeter BS, Kavookjian J (2014) Telephone-based motivational interviewing for medication adherence a systematic review. Transl Behav Med 4 372-381 Timmerman L, Stronks DL, Groeneweg JG, Huygen FJ (2016) Prevalence and deteiminants of medication non-adherence in chronic pain patients a systematic review. Acta Anaesthesiol Scand60(4) 416 31... 

The development of polymeric drug delivery devices for sustained ophthalmic CsA release is an active area of research for uveitis, vitreous inflammation, dry eye, and prevention of cornea transplant rejection. The use of these specialized CsA-delivering ophthalmic systems (e.g., implants nanoparticle and microsphere injections) cannot be completely reviewed in this chapter and readers are referred to an alternative text. A sample of applicable polymers for delivery of CsA for uveitis and vitreous inflammation is offered in the accompanying table (Table 15.4). The treatment of posterior uveitis and vitreous inflammation usually involves chronic therapy (often years) of topical agents and frequent intravitreal injections for disease control. These therapies are often impractical and subject to medical non-adherence [33]. Polymeric implants or injectable polymer sustained release systems can potentially improve patient outcomes through optimized intraocular drug concentrations. 

This referral could mean many thirds persistent unhappiness, heavy social burdens, personality difficulties, medication non-adherence or severe, treatment-resistant depression. Start from scratch and tiy to brii fresh eyes to the problem. 

Triggers insomnia, stress, drugs, medications, non-adherence... 

HF medications deserves special attention, as it is the most common cause of acute decompensation and can be prevented. As such, an accurate history regarding diet, food choices, and the patient s knowledge regarding sodium and fluid intake (including alcohol) is valuable in assessing dietary indiscretion. Nonadherence with medical recommendations such as laboratory and other appointment follow-up can also be indicative of non-adherence with diet or medications. 

Monitor frequency of patient exacerbations. Frequent exacerbations, unscheduled clinic visits, emergency department visits, and hospitalizations due to asthma may indicate a non-adherent patient or the need to step up long-term control medications. 

Since early detection and intervention in schizophrenia is important for maximizing outcomes, treatment with antipsychotic medications should begin as soon as psychotic symptoms are recognized. Antipsychotic medications are the cornerstone of therapy for people with schizophrenia, and most patients are on lifelong therapy since non-adherence and discontinuation of antipsychotics are associated with high relapse rates. If other symptoms are present such as depression and anxiety, these symptoms should also be aggressively treated. Additionally, psychosocial treatments should be used concomitantly to improve patient outcomes. 

Non-adherence may not be more prevalent in older patients and there is no consensus in the literature that age is a predictor of poor adherence (Hughes 2004). Indeed, older patients may deliberately choose not to adhere to medication... 

Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrtme Database Syst Rev 2 CD000011 Ho PM, Lambert-Kerzner A, Carey EP et ai (2014) Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge a randomized clinical tritil. JAMA Intern Med 174 186-193 Ho SC, Chong HY, Chaiyakunapruk N, Tangiisuran B, Jacob SA (2016) Clinical and economic impact of non-adherence to antidepressants in major depressive disorder a systematic review. J Affect Disord 193 1-10... 

Tomaszewski M, White C, Patel P et al (2014) High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis. Heart 100 855-861 Viswanathan M, Golin CE, Jones CD et al (2012) Interventions to improve adherence to self-administered medications for chronic diseases in the United States a systematic review. Ann Intern Med 157 785-795... 

Explain that medications or drugs may be causing his symptoms. This may help Niruban to openly discuss drug use or non-adherence. 

Obtain a thorough history of prescription, non-prescription, and dietary supplement use. Assess inhaler technique and adherence to the medication regimen. Ask the patient about effectiveness of medications at controlling symptoms and adverse effects. 

Obtain a thorough history of non-prescription, prescription, and alternative or herbal drug use. Determine adherence with the medication regimen and whether barriers to care exist. Does the patient have the financial ability and transportation to obtain their prescriptions ... 

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