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Unit 2 Draft (Adding a Section to Antidepressant)

Adherence
See also: Adherence (medicine)

Medication adherence is defined by the World Health Organization (WHO) as how closely patients follow the instructions given by their practitioner. The WHO estimates that worldwide, 40-70% of patients prescribed antidepressant medications do follow their practitioner's instructions. In the United States, it is predicted that up to 50% of patients do not take their antidepressants as directed by their practitioner.

Adherence Measurement Tools
Adherence is primarily measured through tracking pharmacy refill data and administering patient questionnaires. Quantitative measurement tools include:

Medication Possession Ratio
The Medication Possession Ratio (MPR) tracks adherence using prescription refill data. MPR is an expression of the percentage of time that a patient has medication available, but does not take into account whether or not a patient is taking their medication correctly. This can often lead to an overestimation of adherence.

$$MPR=\left ( \frac{Sum\ of\ days'\ supplies\ for\ all\ fills\ in\ period}{Number\ of\ days\ in\ period} \right ) x 100%$$

Proportion of Days Covered
Proportion of Days Covered (PDC) is another expression of the percentage of time that a patient has medication available. By accounting for patients refilling their medication early, PDC can provide a clearer representation of adherence. Much like MPR, PDC still does not account for whether or not medication is being taken properly.

$$PDC=\left ( \frac{Number\ of\ days\ in\ period\ covered}{Number\ of\ days\ in\ period} \right ) x 100%$$

Barriers to Adherence
The WHO groups barriers to antidepressant adherence into five categories; health care team and system-related factors, social and economic factors, condition-related factors, therapy-related factors, and patient-related factors. Common barriers include:

Implications of Non-Adherence
Widely studied implications of non-adherence are clinical and economic in nature. Common clinical implications include greater risk for relapse and hospitalization, increased symptom severity, and reduced remission rates. Common economic implications include higher medical and total healthcare spending. Less studied implications include reduced communication with the provider, increased use of sick leave, and decreased productivity. It is estimated that medication non-adherence is responsible for up to 69% of all hospitalizations in the United States. The total cost of medication non-adherence on the United States healthcare system is estimated to be $100 billion per year.

Solutions to Non-Adherence
Researchers have developed many solutions to help improve adherence, with most utilizing a therapeutic, technological, or communication approach. Proposed solutions include: Article Evaluation: Independent Pharmacy 1.)Is everything in the article relevant to the article topic? Is there anything that distracted you? All of the information included in this article is relevant to independent pharmacy practice. The incorporation of insurance practices in the section about Independent Pharmacy in Rural America did serve to be a bit distracting. 2.)Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position? The only somewhat biased statement appears to be "Independent pharmacy owners generally have high standards of customer service and strive to outperform chain pharmacy competitors." This can possibly imply that pharmacists outside of independent pharmacy are somewhat inferior. 3.)Are there viewpoints that are overrepresented, or underrepresented? Information about what makes independent pharmacies special appears to be heavily represented through including positive survey results, but potential drawbacks to using an independent pharmacy are not addressed. 4.)Check a few citations. Do the links work? Does the source support the claims in the article? The citation links do work, and the sources support the claims made in the article. 5.)Is each fact referenced with an appropriate, reliable reference? Where does the information come from? Are these neutral sources? If biased, is that bias noted? Many of the facts come from independent survey organizations, and thus can be considered relatively neutral. 6.)Is any information out of date? Is anything missing that could be added? Most of the information appears to have come from sources that have been published after 2010, meaning they are fairly up-to-date. The article could benefit from the addition of criticism and drawbacks associated with an independent pharmacy. 7.)Check out the Talk page of the article. What kinds of conversations, if any, are going on behind the scenes about how to represent this topic? There is no activity on the article's talk page. 8.)How is the article rated? Is it a part of any WikiProjects? The article is rated as "stub-class," and is part of the business WikiProject. 9.)How does the way Wikipedia discusses this topic differ from the way we've talked about it in class? Overall, the presentation and discussion of this topic is fairly consistent with the way discussed in class.