Effectiveness of PictureRxTM on perceived medication adherence in the independently living older adult

Abstract

Background: Medication adherence refers to the concept that at least 80% of a prescribed medication therapy including dosage, frequency, and duration of treatment is followed (World Health Organization, 2017). Failure to adhere to one’s prescribed medication regimen is a serious issue that affects both the patient and the entire health care system. Medication non-adherence is especially dangerous for older adults due to their increased risk for multiple comorbidities, polypharmacy, and related adverse effects. According to the World Health Organization (WHO, 2017), medication non-adherence is the cause of approximately 125,000 deaths and 10% of hospitalizations every year, and it costs the health care system between $100-$289 billion. The older adult currently represents approximately 6.4% of the population, with numbers increasing by 800,000 every month (WHO, 2017). Due to the fact that medication non-adherence is linked to increased admissions to acute care facilities, poor health outcomes, increased medical expenditures, and medication resource wastage, enhancing medication adherence in this population is essential to improving health outcomes and preventing further deterioration in health or premature death. Methods: The aim of this quality improvement (QI) project was to implement personalized illustrated medication schedule cards to address the three most prevalent barriers to medication adherence identified within the older adult population living in two independent living facilities. These barriers include (a) the inability to name all prescribed medications taken each day, (b) the inability to state why one is taking each medication, and (c) the perception of negative side effects after taking prescribed medications. All participants were given a personalized illustrated medication card that lists all of their prescribed medications. The medication schedule card was implemented for six weeks. The implementation phase began with preintervention testing, medication reconciliation, the creation and disbursement of the medication schedule cards, and two educational sessions. Measure: The efficacy of the personalized medication schedule was measured using the Adherence to Refills and Medication Scale (ARMS) and the Self-Efficacy for Appropriate Medication Use Scale (SEAMS). In addition, participant satisfaction regarding the perceived ease of use and utility of the illustrated medication schedule card was assessed with a post-intervention satisfaction survey. Conclusion: The strongest evidence found to improve medication understanding and self-efficacy in taking medications in the elderly population is by implementing personalized illustrated medication schedule cards. Illustrated medication schedule cards were found to be most beneficial in helping patients to understand the purpose of medications (40%), adhere to dosing schedules (30%), and remember the names of the medication (25%) (Martin, Kripalani, & DuPapau, 2012). Furthermore, personalized medication schedule cards increased patients’ confidence in taking medications (from 30% to 70%), were highly rated, and were used regularly among participants (Martin et al., 2012). While many patients will not request assistance with medication administration, it is essential that providers identify those who are at risk for low adherence and provide additional education or assistance using the teach back methodology and cognitive prothesis.