Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain
Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary
Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.
The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF).
Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.
Mr. EBR’s physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally
- What would you add to the current treatment plan? Why?
- Would you discontinue any of the currently prescribed medication? Why or why not?
- How does the diagnosis stage 3 chronic kidney disease affect your choices?
- Why is the patient prescribed more than one antihypertensive?
- What is the benefit of the aspirin therapy in this patient?
EXPERT ANSWER AND EXPLANATION
Coronary Artery Disease (CAD) Treatment Plan
What to Add in Current Treatment Plan
Most of Mr. EBR’s medications are functioning well. For instance, Atenolol 25 mg PO bid and Lisinopril 20 mg PO bid given to him has helped in controlling his BP and thus improving his health in terms of Hypertension. Also, his diabetes has been improved by metformin 500 mg PO bid medication. However, a painkiller and heart-related treatment are not working well. Thus, I would recommend another treatment plan for the patient to reduce the effects of coronary artery disease. I would recommend other cholesterol-modifying medications, such as and also ask the patient to conduct more exercises.
Medication to Discontinue
The only medication that I would discontinue is Simvastatin 80 mg PO. I would discontinue the medication because it is not helping the patient deal with the heart condition. Instead, I would recommend atorvastatin (Lipitor). Atorvastatin is a first-line treatment for the heart-related condition (Wang et al., 2019). I help the patient with lower cholesterol levels. I will not interfere with other medications because they show positive effects.
Effects of Stage Three Chronic Kidney on Medication
According to Bruchfeld and Lindahl (2019), stage three, CKD, is a condition where the patient’s kidney is moderately damaged. The condition might affect the nurse’s choice drugs because of the cost of drugs that treat kidney related-conditions. If provided with an expensive drug prescription, the patient might fail to all the medication. Another reason is the medications may be too many, and thus the patient might fail to take all of them. Lastly, my choice of drugs can be affected by side effects of atorvastatin and CKD drugs on the patient’s health.
Why the Patient Takes Many Antihypertensive
Antihypertensive are a group of medications used for treating high blood pressure. Healthcare professionals prescribe drugs, depending on the level of the disease. Also, the drugs may be prescribed based on the age of the patient. In this case, the patient was given many antihypertensive drugs because his blood pressure was too high. Also, the nurse may have recommended the drugs because the patient’s immune is low due to his age. The other diseases affecting the patient may have also contributed to the prescription of more than one antihypertensive drug.
Benefits of Aspirin Therapy
The first benefit of aspirin to this patient is that it reduces the risks of developing stroke and heart attack. The patient is an older person, and thus the risks suffering from dementia. According to Cahill et al. (2019), using aspirin can reduce the risk of suffering from the disease. The patient can also use the drug to relieve pain.
Bruchfeld, A., & Lindahl, K. (2019, March). Direct acting anti‐viral medications for hepatitis C: Clinical trials in patients with advanced chronic kidney disease. In Seminars in dialysis (Vol. 32, No. 2, pp. 135-140).
Cahill, K. N., Cui, J., Kothari, P., Murphy, K., Raby, B. A., Singer, J., … & Laidlaw, T. M. (2019). Unique Effect of Aspirin Therapy on Biomarkers in Aspirin-exacerbated Respiratory Disease. A Prospective Trial. American Journal of Respiratory and Critical Care Medicine, 200(6), 704-711.
Wang, X. L., Qi, J., Shi, Y. Q., Lu, Z. Y., Li, R. L., Huang, G. J., … & Li, Y. (2019). Atorvastatin plus therapeutic ultrasound improve postnatal neovascularization in response to hindlimb ischemia via the PI3K-Akt pathway. American Journal of Translational Research, 11(5), 2877.
How to Improve Patient Compliance with Medication
As healthcare providers, one of the biggest challenges we face is getting patients to take their medication as prescribed. Poor medication adherence can lead to worsened health outcomes, increased healthcare costs, and even death. Fortunately, there are strategies that can be implemented to improve patient compliance with medication. In this article, we will discuss the most effective ways to increase medication adherence and ensure patients receive the full benefits of their medication.
Understanding Medication Adherence
Before we can improve medication adherence, it’s important to understand what it is and why it matters. Medication adherence refers to the extent to which patients take their medication as prescribed. This includes taking the right dose at the right time, following any special instructions (e.g., taking with food), and continuing to take the medication for as long as prescribed. Poor medication adherence can lead to a range of negative outcomes, including:
- Reduced effectiveness of the medication
- Worsened symptoms and health outcomes
- Increased risk of hospitalization and death
- Increased healthcare costs
Factors Affecting Medication Adherence
There are many reasons why patients may struggle to adhere to their medication regimen. Some of the most common factors that can affect medication adherence include:
- Difficulty managing multiple medications
- Side effects or other adverse reactions
- Cost or lack of insurance coverage
- Language barriers or limited health literacy
- Beliefs or attitudes about medication
- Lack of trust in healthcare providers
Strategies to Improve Medication Adherence
Now that we understand some of the factors that can affect medication adherence, let’s explore some strategies that can be implemented to improve it.
Educate Patients About Their Medication
One of the most important things healthcare providers can do to improve medication adherence is to educate patients about their medication. This includes explaining the purpose of the medication, how it works, and any potential side effects or interactions. It’s also important to provide clear instructions for taking the medication, including when and how to take it, and what to do if a dose is missed.
Simplify Medication Regimens
Patients who are prescribed multiple medications or complex regimens may struggle to keep track of everything they need to do. Simplifying medication regimens can be an effective way to improve medication adherence. This may include:
- Consolidating medications into a single pill or capsule
- Switching to long-acting formulations
- Reducing the number of doses per day
- Using pill boxes or other reminder systems
Address Barriers to Medication Access
For some patients, medication adherence may be a challenge due to cost or lack of insurance coverage. Healthcare providers can help address these barriers by:
- Prescribing generic medications when possible
- Connecting patients with patient assistance programs or other resources
- Working with insurance companies to ensure coverage for necessary medications
Use Technology to Support Medication Adherence
Technology can be a powerful tool to support medication adherence. Some ways technology can be used include:
- Text message reminders
- Mobile apps for medication management
- Electronic pill dispensers
- Telemedicine for virtual medication management
Engage Patients in Their Healthcare
Patients who feel engaged and empowered in their healthcare are more likely to adhere to their medication regimen. Healthcare providers can engage patients by:
- Encouraging questions and dialogue
- Providing resources and education materials
- Involving patients in treatment decision-making
Improving medication adherence is essential to ensuring patients receive the full benefits of their medication. By educating patients, simplifying medication regimens, addressing barriers to access, using technology, and engaging patients in their healthcare, healthcare providers can improve medication adherence and improve health outcomes.
Why Medication Adherence Is Crucial: The Benefits and Challenges
Medication adherence, or the act of taking medications as prescribed by healthcare professionals, is a critical factor in achieving and maintaining good health. In this article, we’ll explore the reasons why medication adherence is essential, the challenges patients face in adhering to their medications, and strategies to improve medication adherence.
Medication adherence is a critical component of successful medical treatment. Unfortunately, many patients struggle to adhere to their medication regimens, leading to poor health outcomes, increased healthcare costs, and reduced quality of life. In this article, we’ll explore the reasons why medication adherence is crucial and strategies to improve adherence.
What is medication adherence?
Medication adherence refers to the extent to which a patient takes their medications as prescribed by their healthcare provider. Adherence can be affected by many factors, including the complexity of the medication regimen, patient education and communication, financial concerns, and mental health issues.
The Importance of Medication Adherence
Adherence to medication is crucial for many reasons. Firstly, adherence is essential for achieving optimal health outcomes. Medications are prescribed to manage and treat medical conditions, and failure to adhere to the prescribed regimen can result in poor outcomes, including disease progression, complications, and hospitalization.
Secondly, medication adherence is essential for controlling healthcare costs. Non-adherence leads to increased healthcare costs, including hospitalizations, emergency department visits, and medication-related adverse events.
Finally, medication adherence is crucial for improving the quality of life of patients. Many medical conditions can impact a patient’s quality of life, and adherence to medication can help manage these conditions and improve overall well-being.
Benefits of Medication Adherence
Adherence to medication has numerous benefits for patients, including:
- Improved health outcomes
- Reduced risk of complications and hospitalization
- Better disease management
- Improved quality of life
- Reduced healthcare costs
Consequences of Non-Adherence
Failure to adhere to medication regimens can have serious consequences for patients, including:
- Disease progression
- Adverse medication events
- Reduced quality of life
Challenges to Medication Adherence
Many factors can affect a patient’s ability to adhere to their medication regimen, including:
- Complexity of the medication regimen
- Lack of patient education and communication
- Mental health issues
- Financial concerns
- Side effects of medication
Strategies to Improve Medication Adherence
There are many strategies healthcare providers can use to improve medication adherence, including:
Education and Communication
Patient education and communication are essential for improving medication adherence. Healthcare providers should take the time to explain the importance of medication adherence, potential side effects of medication, and strategies for managing side effects.
Simplify the Medication Regimen
Simplifying the medication regimen can improve adherence. Healthcare providers should consider consolidating medications and reducing the frequency of dosing to make it easier for patients to adhere to their medications.
Use Reminder Systems
Reminder systems, such as pillboxes and smartphone apps, can help patients remember to take their medications as prescribed.
Address Financial Concerns
Financial concerns can be a significant barrier to medication adherence. Healthcare providers should work with patients to address financial concerns and find ways to reduce the cost of medications.
In conclusion, medication adherence is a critical component of successful medical treatment. Adhering to medication regimens can lead to improved health outcomes, reduced healthcare costs, and improved quality of life. However, many patients face challenges in adhering to their medications, including complex medication regimens, financial concerns, and mental health issues.
Healthcare providers can improve medication adherence by providing patient education and communication, simplifying medication regimens, using reminder systems, and addressing financial concerns. By working together, healthcare providers and patients can achieve improved health outcomes and a better quality of life.
Consequences of Medication Non-Adherence
When it comes to managing a chronic condition, taking medication as prescribed is critical for maintaining good health and preventing complications. Unfortunately, many patients fail to take their medications as directed, leading to a host of negative consequences. In this article, we’ll explore the consequences of medication non-adherence and discuss strategies for improving medication adherence.
Taking medications as prescribed is essential for managing chronic conditions and maintaining good health. Unfortunately, many patients struggle to adhere to their medication regimen, which can have serious consequences for their health and wellbeing.
II. Consequences of Medication Non-Adherence
A. Increased Risk of Complications When patients fail to take their medications as prescribed, they are at increased risk of developing complications related to their condition. For example, a patient with high blood pressure who fails to take their medication may experience a stroke or heart attack.
B. Reduced Quality of Life Medication non-adherence can also lead to a reduced quality of life. Patients who don’t take their medications as directed may experience more symptoms and have a harder time managing their condition, which can impact their ability to work, socialize, and enjoy life.
C. Increased Healthcare Costs Medication non-adherence can also result in increased healthcare costs. Patients who fail to take their medications as directed are more likely to require hospitalization and other costly medical interventions.
D. Worsening of Condition Finally, medication non-adherence can lead to a worsening of the patient’s condition. This can result in a need for more aggressive treatment or even irreversible damage to the patient’s health.
III. Factors Contributing to Medication Non-Adherence
A. Lack of Understanding Many patients fail to adhere to their medication regimen because they don’t fully understand why the medication is necessary or how it works.
B. Fear of Side Effects Some patients may avoid taking their medications because they are afraid of the potential side effects. This can be especially true for medications with known side effects, such as chemotherapy drugs.
C. Complexity of Medication Regimen Patients may also struggle to adhere to their medication regimen if it is too complex or difficult to follow. This can be especially true for patients with multiple chronic conditions who require multiple medications.
D. Cost of Medications Patients may also fail to take their medications as directed due to the cost of the medication. This can be especially true for patients who are uninsured or underinsured.
E. Lack of Social Support Finally, some patients may struggle to adhere to their medication regimen due to a lack of social support. Patients who don’t have a support system may find it more difficult to manage their condition and stay on top of their medication regimen.
IV. Strategies for Improving Medication Adherence
A. Patient Education and Empowerment
One of the most effective ways to improve medication adherence is through patient education and empowerment. By helping patients better understand their condition and their medications, healthcare providers can increase the likelihood that patients will take their medications as prescribed.
B. Simplification of Medication Regimens
Another strategy for improving medication adherence is to simplify the medication regimen. This can be achieved by reducing the number of medications a patient takes, reducing the frequency of dosing, or using combination medications.
C. Use of Technology
Healthcare providers can also leverage technology to improve medication adherence. This can include using reminders, such as text messages or phone calls, to help patients remember to take their medications.
D. Reduction of Medication Costs
Reducing the cost of medications can also improve medication adherence. Healthcare providers can work with patients to find lower-cost alternatives or connect them with resources that can help them afford their medications.
E. Enhanced Social Support
One of the biggest factors contributing to medication non-adherence is the lack of social support. Patients who lack social support may feel isolated and unsupported, making it more difficult for them to stick to their medication regimen. Social support can come in many forms, including emotional support, practical support, and informational support.
Emotional support can be provided by friends and family members who listen to the patient’s concerns and offer encouragement. Practical support can include help with transportation to medical appointments, assistance with household tasks, or other forms of practical assistance. Informational support can come from healthcare providers who explain the benefits of medication and how to manage side effects.
One way to enhance social support is to involve family members and friends in the patient’s care. This can include inviting them to medical appointments, encouraging them to ask questions, and involving them in medication management. Another strategy is to connect patients with peer support groups, where they can connect with others who are going through similar experiences and share tips for managing medication.
Overall, enhancing social support is a crucial component of improving medication adherence. By providing patients with the support they need, they are more likely to feel motivated and empowered to manage their medication regimen effectively.
Medication non-adherence is a widespread problem that can have serious consequences for patients. It can lead to poor health outcomes, increased healthcare costs, and decreased quality of life. Fortunately, there are many strategies for improving medication adherence, including patient education and empowerment, simplification of medication regimens, the use of technology, the reduction of medication costs, and enhanced social support.
By working together, healthcare providers, patients, and caregivers can help to address the factors contributing to medication non-adherence and support patients in managing their medications effectively. With the right support and resources, patients can take control of their health and improve their overall well-being.