Adherence to Prescription Medications
I think everybody needs to know about adherence. What adherence is, is how somebody takes medication.
Are you taking it regularly? Are you taking it properly? There’s medications that are taken, but if you’re not sticking with what you’re instructed to do, such as, let’s say, taking on an empty stomach, or has to be taken with water only, not coffee, not juice, not anything else – that’s part of what adherence is.
This is different from persistence. Persistence means you’re taking it, but if it’s not properly taken, you might as well not even be taking it. Drugs like bisphosphonates, they are a drug that binds to pretty well everything. That’s why you need to take it only with plain water. Even mineral water becomes a problem because it will bind to the minerals within mineral water.
It just illustrates to you how important adherence is, and people don’t recognize that. Sometimes even your doctor and caregiver don’t recognize how important it is to take a drug regularly and properly. It’s not just that it’s taken, but it’s taken how it’s prescribed, and taken with all the other instructions of how it’s to be taken.
Most people think they can take medications on a regular basis, and when they’re asked by their doctor, they’ll always answer, “Yes, I’m taking my medications.” Sometimes the doctors prompt you in the wrong way. They might say, “You’re taking your medications, aren’t you?”
The thing is, you do have to respond accordingly, and do it as accurately as you can tell your doctor. That way, they can make a consideration whether you might need another kind of medication, another option, another version of it that might be easier for you to take.
Studies actually tell us that 20 to 30 percent of people actually don’t even fill their medication prescriptions. On top of that, up to half of them stop taking their medications properly within a year. That means 50 percent of the people out there who are actually getting medications aren’t actually even taking them properly, and not getting the full effect from their drugs.
It is very important to understand what your options are for taking medications. Medications aren’t only available as oral. You’ll find that medications can be injectable. There are patches and many other ways to take medications.
If we use osteoporosis as an example, you can take pills once a day, once a week, once a month. There’s also a subcutaneous injection, which is actually once every six months. There’s an IV infusion that’s once a year. All of these options are available to you.
If you speak with your doctor, they can speak with you about what your risks and benefits are, and what your preferences are to find the best medication for you.
Presenter: Dr. Alan Low, Pharmacist, Vancouver, BC
Local Practitioners: Pharmacist
Dr. Alan Low, Pharmacist, Vancouver, British Columbia
Dr. Low has a wide range of experience in various sectors: direct patient care in hospitals and clinics, academics, research, health care consulting and pharmaceutical industry perspective. He has presented at local and international conferences and is a Fellow of the Canadian Society of Hospital Pharmacists, Clinical Associate Professor in the Faculty of Pharmaceutical Science at the University of British Columbia and former Chief Operating Officer at Network Healthcare.
Following a career that has seen pharmacist Dr. Alan Low wears many hats — hospital practitioner, researcher, advisor, instructor, author, speaker, corporate officer — in February 2017 the pharmacy practitioner applied his decades of practical experience and clinical knowledge when opening an innovative pharmacy, BioPro Biologics Pharmacy.
“After a wide variety of roles, I was thrilled to be back in frontline pharmacy practice,” says Low. “I wanted to create a different kind of pharmacy with a service model centred on exceptional patient care.”
Located along Vancouver’s busy health-care corridor on W. Broadway, just steps from Vancouver General Hospital and connected to the largest rheumatology clinic in Western Canada, BioPro Biologics is a haven for patients suffering with rheumatism, arthritis, dermatological conditions and osteoporosis.
“Although there is a large population of rheumatology patients, this is a tailored pharmacy experience with high quality, targeted patient care, regardless of the conditions they have,” Low says.
The pharmacy helps patients navigate through the myriad of anti-inflammatory treatment options available, educating on benefits and risks, while also collaborating with prescribers to ensure optimal treatment plans that best fit each patient’s needs and preferences. Patient consultations are conducted in semi-private consultation areas or private consultation pods equipped with computer screens to fully engage patients on their own health journey through the use of visual aids.
Serving many patients with complex medical needs, Low’s team provides a number of valuable clinical services designed to optimize drug care and improve health outcomes. There is a heavy emphasis placed on deprescribing, working with patients and their prescribers to conduct full medication reviews and assess the efficacy and safety of current drug regimens for the individual. Low’s team works collaboratively with specialist physicians and nurses, sharing access to patients’ electronic medical records (EMR) and provides regular, ongoing follow-ups. Low also works with patients interested in alternative treatments, offering care plans that test out alternative therapies in tandem with placebos to produce evidence-based therapy solutions.
Low’s team was an early adopter of innovative approaches to care. They support the use of new technologies in treating patients, whether that is guiding patients in their use of helpful apps or devices for medication reminders or serving as the location for the world’s very first SOLIUS device, a futuristic pod that stimulates the body’s natural production of Vitamin D, staving off depression, premature aging and poor bone health.
As a Clinical Associate Professor with the University of British Columbia (UBC) and longtime preceptor for pharmacy students, education — for patients, pharmacy students and fellow health-care colleagues — is paramount to Low. He regularly hosts education forums in the pharmacy, covering a wide range of topics from self-management to preventative care. He partners with the Arthritis Society and others to deliver monthly education services to public and also invites physicians and other health-care practitioners to participate in education discussions at the pharmacy.
“There is a lot of value that we as pharmacists can bring to this group of patients, and that’s what attracted me to this area of specialty,” says Low.
Since graduating with his pharmacy degree in the early 1990s, Low has been diligent in his quest to progress the practice of pharmacy in B.C. In 1998, he was the first to create an online pharmacology course in the School of Health Sciences at the Justice Institute of B.C. He was instrumental in the establishment of the Pharmacists Clinic at UBC’s Faculty of Pharmaceutical Sciences, the first academic pharmacy practice site of its kind in Canada. He was the first in Canada to launch a business plan competition, the Pharmacy Moguls’ Den, for pharmacy students to present sustainable business plans for patient care services, and is currently the course coordinator of the Pharmacy Practice Management and Leadership Course for third-year pharmacy students.
Looking into the future, Low sees that once pharmacists demonstrate their value, the public will recognize them as integral care providers in the health team when it comes to the optimal use and management of medications. Now health Network