Question 5 of the Morisky 8-item scale, "Did you take your medication(s) yesterday?" is designed to assess medication adherence, specifically focusing on whether the individual took all their prescribed medications on the previous day. This question indirectly addresses the issue of polypharmacy, which refers to the simultaneous use of multiple medications by an individual.
Polypharmacy can be influenced by various factors, including the presence of multiple chronic conditions, the use of medications for symptomatic relief, the involvement of multiple healthcare providers, and the aging population. While polypharmacy may be necessary to manage complex health conditions, it can also increase the risk of medication non-adherence.
Medication non-adherence can occur for several reasons within the context of polypharmacy:
1. Complexity: Managing multiple medications can be challenging, especially when different medications have different dosing schedules, instructions, and potential interactions. The complexity of the medication regimen can lead to confusion, forgetfulness, and errors, resulting in non-adherence.
2. Side effects: Some medications may cause unpleasant side effects, and when multiple medications are involved, the cumulative burden of side effects can contribute to non-adherence. Individuals may decide to skip or reduce the dosage of certain medications to alleviate side effects.
3. Cost: The financial burden of multiple medications can be a barrier to adherence. Some individuals may be unable to afford the prescribed medications, leading them to skip doses or ration their medications to make them last longer.
4. Lack of understanding: Polypharmacy often involves a higher level of complexity and information to understand. If individuals do not fully comprehend the reasons behind their medication regimen, the importance of each medication, or potential risks and benefits, they may be more likely to be non-adherent.
Addressing polypharmacy and its role in medication non-adherence requires a comprehensive approach. Healthcare providers should strive to optimize medication regimens by considering the potential for drug interactions, prioritizing essential medications, and simplifying dosing schedules when possible. Additionally, clear communication and patient education are crucial to ensure individuals understand the purpose of each medication and how to take them properly.
Regular medication reviews, involving medication reconciliation and deprescribing when appropriate, can help minimize polypharmacy and reduce the risk of non-adherence. Collaborative efforts between healthcare providers, pharmacists, and patients are essential to optimize medication management and improve adherence among individuals with complex medication regimens.
Dr Donald Morisky.