Adherence is everything when it comes to weight loss success following bariatric surgery. However, adherence applies to more than diet and exercise. Adherence to supplement and medication regimens is also essential for ongoing health and wellness.
Unfortunately, this is not as easy as it sounds — particularly when you factor in that adherence is a universal healthcare problem. Here’s a closer look at the issue of adherence, along with a roundup of four tools designed to help bariatric patients improve their medication adherence and stay on track.
According to research published in the academic journal Therapeutics and Clinical Risk Management: “Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40 percent of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice.”
Lack of adherence is a complex and multi-factored challenge with no single intervention strategy. Not only that, but bariatric patients may be uniquely challenged when it comes to complying with new medication regimens.
Why? Because “when preventive or treatment regimens are very complex and/or require lifestyle changes and the modification of existing habits, nonadherence can be as high as 70 percent.” As dietitians, we are well-aware that weight loss surgery success is ultimately about the ability to change bad habits and embrace new ones.
A number of factors influence adherence (and non-adherence), including patient awareness of the importance of supplements and medications; understanding of the regimen; and open lines of communication between patients and their healthcare teams.
But it also comes down to something more basic: the ability to remember details regarding when and how to take medication. Proposes The Challenge of Patient Adherence, “Studies have repeatedly shown that forgetting to take (or how to take) medications is a major contributor to nonadherence.”
But patients don’t have to do it alone. In fact, many strategies can help patients stay compliant, including educational interventions, behavioral interventions, self-management interventions, risk communication interventions, packaging, and daily reminders. Implementing these strategies can make a huge difference. In fact, research indicates that the use of medication reminder systems can lead to a 65 percent increase in adherence.
Dietitians can support their patients in optimizing adherence by educating them about the adherence imperative. RDs can have an even greater impact, however, by pointing patients in the direction of medication management systems which might best suit their individual behaviors and lifestyles.
Thanks to technological advancements, patients have more options than ever when it comes to medication management success, including the following:
Suggests Pharmacy Times: “Sending patients home from the pharmacy with their medications presorted into batches as they are meant to be taken can go a long way toward reducing the number of missed and mistimed doses. For example, software and blister packaging systems from Medicine-On-Time (www.medicine-on-time.com) can help achieve this goal.”
Adherence packaging can be particularly useful for patients who may not be technologically inclined. Explains Pharmacy Times: “Patients who receive their prescriptions from pharmacists using Medicine-On-Time receive a calendar card that has pockets filled with the tablets they need to take together. The cards come in varying sizes, and the pockets can be filled according to the day or time. Each of the cards and individual pocket seals can be labeled with the name(s), dosage(s), and special instructions for their contents, as well as with the patient's name and other relevant information.”
Dosing alarms render the phrase “out of sight, out of mind” obsolete. Phones, watches, tablets and other timers can be set to sound alarms when medication is due. Internet-connected timers with the capacity to do everything from light up to sound a phone alarm can even be attached to medicine container caps.
There are many options for pill organizers, including basic boxes with compartments labeled for days of the week to complex automatic dispensers. Again, helping patients identify the pill organizer that best meets their unique lifestyles is a beneficial way to facilitate compliance.
Smartphone applications serve a breadth and depth of functions, including listing patients’ medications, scheduling pill reminders and helping patients order refills. Says research published in the Journal of the American Pharmacists Association, “Adherence apps are inexpensive, scalable, accessible to anyone with smartphones, and do not require separate devices or packaging, which allows them to be easily implemented.”
Again, a tool is only as effective as its use. In other words, while smartphone apps may be an ideal solution for on-the-go, mobile-minded patients, less technologically savvy patients may be better suited by alternate medication management methods. Looking for more information on medication management tools? Websites like epill.com and ForgettingthePill.com offer a variety of medication adherence tools for bariatric surgery patients.
Keep in mind that while these medication management tools are helpful, they’re not solutions in and of themselves. Cautions research published in the academic journal, Patient Preference and Adherence: “Strategies directed at improving medication-taking behavior should target the underlying barriers to adherence. Reminders may therefore provide a useful adjunct to adherence-enhancing strategies, particularly in populations for whom recurrent cues are helpful in [ensuring] correct medication usage.”