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SAFTINet Cardiovascular Cohort PRO: Medication Adherence

CER Team2 July 2012

+Overview

PEC preference regarding the medication adherence measure Instrument Pilot test

Feedback on the instrument Feedback on the pilot How would we use the findings in our research?

+Overview

PEC preference regarding the medication adherence measure Instrument Pilot test

Feedback on the instrument Feedback on the pilot How would we use the findings in our research?

+Proposed Med Adherence Instrument and Pilot Test A single medication adherence question (derived from

the Gehi question) and a single checklist of barriers Pilot test by 1-2 providers in each organization for a

few weeks

+Proposed Med Adherence Instrument: Adherence Question Patient Instructions:

It can be difficult to take all of our medications as the doctor has told us to. Please tell us how often taking your medications is difficult for you.

In the past month, how often did you take your medications as the doctor or provider prescribed?1 Please check one (1) answer. “All of the time” (100%) “Nearly all of the time” (90%) “Most of the time” (75%) “About half the time” (50%) “Less than half the time” (<50%) “None of the time” (0%)

+Proposed Med Adherence Instrument: Barriers Checklist In the past month, why have you not taken your

medicine as your doctor prescribed? Check all that apply. My medicine makes me feel bad (I have “side effects”).

Please describe: ________________ I don’t feel like my medicine is working I feel like taking my medicine will not improve my health There are too many doses of medicine to take each day I cannot afford my medicine I forget to take my medicine

+Proposed Med Adherence Instrument: Barriers Checklist Domains for Barriers:

Side effects No improvement in symptoms Belief medication won’t change outcomes Complexity of regimen Financial cost Forgetting

Some options for wording on next slides

+Proposed Med Adherence Instrument: Barriers Checklist Domain for Barriers: Side effects Options

proposed: My medicine makes me feel bad (I have “side effects”). Please describe: ________________

ASK-12: Have you skipped or stopped taking a medicine because it made you feel bad?

Morisky-8: Have you ever cut back or stopped taking your medicine without telling your doctor because you felt worse when you took it?

Morisky-4: At times, if you feel worse if you take your medicines, do you stop taking them?

+Proposed Med Adherence Instrument: Barriers Checklist Domain for Barriers: No improvement in symptoms Options

proposed: I don’t feel like my medicine is working ASK-12:

I feel confident that each one of my medicines will help me

Have you skipped or stopped taking a medicine because you did not think it was working?

+Proposed Med Adherence Instrument: Barriers Checklist Domain for Barriers: Belief medication won’t change

outcomes Options

proposed: I feel like taking my medicine will not improve my health

ASK-12: I feel confident that each one of my medicines will help

me Have you skipped or stopped taking a medicine because

you did not think it was working?

+Proposed Med Adherence Instrument: Barriers Checklist Domain for Barriers: Complexity of regimen Options

proposed: There are too many doses of medicine to take each day

ASK-12: Taking medicines more than once a day is inconvenient

+Proposed Med Adherence Instrument: Barriers Checklist Domain for Barriers: Financial cost Options

proposed: I cannot afford my medicine ASK-12:

I feel confident that each one of my medicines will help me

Have you skipped, stopped, not refilled, or taken less medicine because of the cost?

+Proposed Med Adherence Instrument: Barriers Checklist Domain for Barriers: Forgetting Options

proposed: I forget to take my medicine ASK-12:

I just forget to take my medicines some of the time I run out of my medicine because I don’t get refills on time

Morisky-8: Do you sometimes forget to take your pills? How often do you have difficulty remembering to take all your

medications? When you travel or leave home do you sometimes forget to bring

your medicine? Morisky-4: Have you ever forgotten to take your medicine?

+Med Adherence Instrument: Provider Guidance, 1st slide Provider Instructions: Please review the patient’s responses

and considering adjusting the treatment plan if patients exhibit difficulty taking their medications. Encouraging adherence to medications is one of the best ways to improve outcomes! Some ideas for helping patients take their medications include:

Side effects: Switch medications, adjust the dose, or recommend other mitigation strategies (e.g., taking the medication with food, reducing salt intake)

Feeling as though the medication does not or will not improve their health: indicate a range of time before seeing results, encourage logging or home monitoring (e.g., blood pressure) so patients can see change

+Med Adherence Instrument: Provider Guidance, 2nd slide Complex regimens: Consider reducing medications, use

combination therapies, design a treatment plan that is easier to follow (e.g., all medications should be taken in the morning), use organizing systems (pillboxes)

Cost: Switch to lower cost medications, facilitate sign-up for prescription assistance plans

Forgetting: Encourage routines, pairing medications with other daily activities, use of memory aids (alarms, pillboxes, calendars), use health IT tools to remind patients to proactively refill prescriptions

+Pilot Timeline

July 10, 2012: Feedback from PEC partners on summary of the instrument

July 20, 2102: Spanish translation of instrument completed July 20, 2012: Partners’ providers for Pilot Test identified Aug 1, 2012: PEC and providers participating in Pilot meet at

regularly scheduled PEC meeting Aug 1, 2012: Feedback questionnaires provided to PEC

partners Aug 13, 2012: Feedback questionnaires returned to

SAFTINet research team

+Pilot Survey, 1st slide

Is the information in the survey useful to you as a clinical provider? Are there questions that are not useful? Are there questions that would be really useful to you that are missing?

Do the respondents feel comfortable answering the questions?

Is the wording of the survey clear? Are there questions that respondents consistently misunderstand? Is there some wording that needs to be changed? Do you have suggestions for better wording?

How long does this survey take to administer?

+Pilot Survey, 2nd slide

Is the survey too long? If so, what question(s) do you suggest we drop? Is there a question we are missing?

Are the “provider instructions” about how to adjust the treatment plan helpful to you? Are they too common-sense? Are they too context-dependent (would be different at different practice sites)?

Did it make sense to administer this survey at the patient’s visit to the clinic? Would it be better administered by phone or by other strategies? If so, how do you suggest we administer it?

Do you prefer to administer the survey to all patients? To only patients with hyperlipidemia or hypertension?

+Overview

PEC preference regarding the medication adherence measure Instrument Pilot test

Feedback on the instrument Feedback on the pilot How would we use the findings in our research?

+Overview

PEC preference regarding the medication adherence measure Instrument Pilot test

Feedback on the instrument Feedback on the pilot How would we use the findings in our research?

+Research Utility

Which domains would we use? medication adherence scale barriers measure total count, or focus on specific barrier(s)

How would we use these in an analytic model?

PCMHMedication adherence

Barriers

Disease control