Formulating medication adherence strategies using the PASSAction framework
Notice bibliographique
Résumé
Completing my final co-op placement at the Canadian Pharmacists Association (CPhA) not only helped me to integrate my prior pharmacy experiences in research, community and hospital practice but made me aware of an area of patient care that I am beginning to grow passionate about—medication adherence. Adherence, as defined by the World Health Organization, is the extent to which a person’s behaviour—taking medication, following a diet and/or executing lifestyle changes—corresponds with agreed-upon recommendations from a health care provider.1 Every year in Canada, patient nonadherence to drug therapy is estimated to cost the health care system $8–$10 billion and is associated with about 140,000 hospital admissions and 35,000 deaths.2 Yet adherence does not appear to be a clinical priority among community pharmacists.3 This phenomenon is compounded by the fact that pharmacists are currently not reimbursed for providing services specifically aimed to improve adherence. Additionally, family physicians perceive inadequate time and financial compensation as barriers that inhibit them from collaborating fully with community pharmacists in order to promote patient adherence.4 Despite a general apathy among health care providers around the problem of nonadherence,2 we should recognize that this is a complex, patient-specific and often multifactorial issue. No single intervention alone has consistently been shown to be effective at improving adherence. Interventions that have increased adherence, improved health outcomes and, in some cases, even reduced health care costs are more likely to use a combination of approaches individualized for the patient’s needs.5-7 In light of these issues, my aim in this commentary is to describe a logical framework that pharmacists can consider using in their daily practice to formulate and implement practical and individualized medication adherence strategies for their patients. This framework was inspired by my past co-op experiences and integrates key messages in some of the Canadian literature published on adherence to date. Abbreviated as PASSAction, this framework encompasses: P—Problem or Patient encounter A—Adherence factor or Align with the medication-taking process SS—Set a focused Strategy Action—put the strategy to Action To illustrate the use of PASSAction, this framework will be applied to 3 real-life cases of actual or potential nonadherence encountered in my co-op experiences. In order for adherence strategies to be effective and sustainable, the application of this framework will also convey the following key concepts: 1) individualize the strategy and adherence intervention, 2) be creative and 3) make use of existing resources.
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| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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