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4.4.  Education, Medication Self-Management, and Adherence

Studies have found more than 50 percent of older adults knew the names and purposes of their medications; however, less than 25 percent knew the consequences of drug omission or toxic side effects. For example, one study of elderly patients with congestive heart failure found that 30 days after a new medication was prescribed, only 64 percent of the patients could identify when they were supposed to take their medicine.

Older adults require specific educational methods.

Also, older adults were found to have insufficient knowledge of inhaler technique and to not understand how medications can improve their asthma. Patient education is a key intervention to assist older adults with medication management. Patient knowledge of drugs is positively associated with adherence.

Education Geared to Older Adults

However, older adults require specific educational methods. Learning is more effective in older adults if information is explicit, organized in lists, and in logical order.

Instructions that are compatible with the older adults’ schema for taking medications are better remembered, and well-organized prescription labels are more useful for older adults. Studies have demonstrated that patient education and counseling over several home visits or with follow-up phone calls increased patients’ medication adherence.

While traditional patient education provides information and technical skills, self-management teaches problem-solving skills. The growing emphasis on self-management recognizes that the patient plays a central role in preventing and managing illness.

For example, a self-management program for 489 chronically ill Kaiser Permanente patients resulted in improved health behaviors and health status. Furthermore, growing evidence from controlled trials suggests that self-management approaches are more effective than information-only education in improving clinical outcomes.

These approaches may also reduce costs and may soon become an integral part of high-quality primary care.

Interventions to Improve Adherence

Additional possible interventions for improving adherence include the following, as outlined in section 3.5:

  • Providing relief for prescription cost, providing low cost insurance, and providing drugs to patients who cannot afford them.
  • Providing home delivery of medications.
  • Educating patients and caregivers, a key driver for medication adherence that can be incorporated in MTR sessions, MTM, and medication reconciliation.
  • Modifying the container label, providing pill boxes, and using blister packs instead of childproof containers for older adults.
  • Providing reminders for patients to take their medications, such as memory cues, electronic personal reminder systems, pill boxes, and telephone call programs, as well as associating medication taking with certain routine activities, such as a meal or bedtime.

A number of technologies facilitate medication adherence, including alerts from the pharmacy when a prescription is not picked up; refill reminders; special packaging to facilitate recognizing, reading or opening medications; medication organizers; personal medication reminders; and personal medication dispensers.

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