So far I've been using my Excel program to enter in the time that I took the medication. Biggest problem sometimes is I don't have the computer with me and I can't enter in the time that the medication was taken. This usually leads to either not entering the time or recounting the medication to see if I did take the medication. Time consuming.
The best ways so far I have used to remember to take my medication is to line it up with something I normally do during the day. I've used breakfast, lunch, and dinner to help mostly but I still am having trouble.
I have been timing my regimen out with meals in a similar way to Derek. I try to take on with my 3 meals and 1 before bedtime. I have also been keeping the "medication" in my pocket and not my bag so that I will periodically stumble upon it and not forget.
Luckily I can take all of my tablets at once, so timing isn't even an issue for me and my warfarin 2.5 mg tablets. For the past few days I have just been taking them at school.. it seems just being here reminds me to do this assignment...my only problem seems to be keeping my medication in a safe spot not to get smashed. Jin your method seems like it requires too much effort and seems like its not real convenient. If you are really into the electronic method you could try an iphone/itouch or even a cellphone calendar?
As I mentioned in question 1, I haven't really tried anything yet except for just will power to remember. This works for the morning and afternoon doses, but not the evening. I will report back about using my phone alarm at night to help remember the third dose and if this helps or not.
On the first day of my regimen, my first dose was at 9am and I missed my second dose at 5pm. I remembered it at 7pm and took it immediately. This threw my schedule off by two hours and I would have to take my third dose at 3am. I decided to skip this third dose because I did not want to wake up in the middle of the night just to take my medication. I took a dose as soon as I woke up the next morning which was at 7am and decided that I would start my dosing schedule over. I used my phone to set alarms for 7am, 3pm and 11pm daily to remind myself to take the medication. I don’t think these times would be a problem especially when I have them set on my phone and I always have my phone with me. I associate the 3pm dose with ICARE because most of our ICARE classes start at 3pm. So far, so good.
I have multiple alarms on my phone set for every 6 hours so that I can take the medication. However, since I have to set my phone to silent during classes, I have regularly forgotten to take my next dose. It has been difficult to keep up with our daily class schedules and adhering to my medication regimen.
Jin, I like your idea about using the Excel spreadsheet. I am usually always near my computer and it would definitely be more useful while I am in class and cannot hear my phone alarm. I think probably even sending an email to oneself (and marking it as unread) with the times that one must take their medications would be useful so it is always in your inbox. I am very "Type A" so this would probably catch my attention more than a spreadsheet.
In regards to the use of spreadsheets, this may work for us as students since we are by a computer most of the time, but in reality this would probably not be an option for the general public. If I was trying to assist a patient on ways to maintain adherence, I really like the idea of cell phone alarms. Cell phones are a staple for most people and they are usually not very far from the person. The idea is kind of similar to those pill boxes with alarms on them as well.
So far, my phone alarm has been working and I have been taking all of my doses. Shabana, you mentioned that you have your phone on silent during class and often miss the alarm. I am not sure how your phone works, but when I miss my alarm, it continues to go off every 5 minutes until I acknowledge it. Therefore, you could either keep your phone on the table so you can see it light up for the alarm during class...or you can just wait until after class and hopefully the alarm will be continuing to go off to remind you to take it as soon as you can. I don't think it is absolutely crucial that these medications be taken at their exact scheduled time. As long as they are plus or minus 30 min to an hour, I think it will still have the same effect and not cause too much damage.
The first thing I would check for this type of patient is if the number of doses can be reduced for any immediate release medications. Pharmacists have the resources to explore alternatives for a patient, whether it be a sustained release dosage form or just a higher strenth, and then present the findings to the doctor for approval. One sustained released tablet can easily replace 2 or more and I am sure adherence grows by leaps and bounds. I feel like this step could put most people's medications together at most or all points of the day.
I would also like to note that most of our classes entries demonstrate how many options are available to our patients to use as reminders for taking medication. Schedules, calendars, alarms, excel, meals, etc. were all used by this group alone. Knowing all of this, it should be possible for each of us to counsel someone on how to take their medications. If a person truly wants to be compliant, then we should definitely have an option that would help them out.
My regimen isn't tough at all to keep up with. Every 12 hours for me is best at 10 and 10. I will usually be up for both these times. However, I agree, Sarah, that most of these aren't crucial to be given on the perfect schedule. With amoxicillin, I am seeking to keep a therapeutic concentration for a 7 day span... so there is an expectation of not missing doses. However, if I must take a dose early or late to keep from missing, it isn't that big of a deal. Some patients on amox are taking 4 doses per day, so there is some wiggle room in my regimen.
As far as remembering, I haven't had much difficulty. I'll take a dose when I am getting ready in the morning, and I am regularly home and showering about the time I need to take the second dose. Some evenings I work until 11, so I catch up with a dose when I get home... rather than risk losing the medication or leaving it at work. Weekends are the tough period though, when I don't have "alone time" before my family wakes... so my morning routine is considerably different. At least I only have one weekend to take this medication, and it is near the end of my abx therapy.
In response to Dr. Clements's question, I can see how some crazy regimens might leave a patient anxious about going into the world without their medicines. Activities might run long and without adequate preparation, you might WANT to take the medication but not even have it available. Thanks Chris for pointing out some major points that might help these patients. When a patient is more compliant, their drugs will work more effectively and might actually save them in healthcare costs by keeping them healthier, even if the tablets are more expensive.
If a patient feels controlled by their medications, it is important to discover what makes them feel this way. It might be as simple as counseling a patient to be more discreet about their insulin administration (children especially) or timing medications around a night-shift worker rather than assuming they operate like a day-shift worker. Medications are prescribed to help prolong enjoyment of life, not destroy it prematurely... but we must ask the right questions in hopes of coming to an appropriate answer.
Kyle, I definitely agree with you that we must ask the patient exactly why they feel confined by their medications in order to help them. We should find ways to fit the medication into the patient’s lifestyle instead of making the patient feel like they have to adjust their whole life around their medication. This means we have to take the time to talk to patients and find out what is important to them. I know that this is difficult to do in busy retail pharmacies and would be unrealistic to talk to every single patient who gets a prescription. However, if a pharmacist could dedicate a bit of their time to even one patient per day it would create a huge impact.
If a patient has to take multiple medication at different times,the first option I would look at is the availability of drugs in the same class which might have a less frequent dosing regimen to make matters less complicated for the patient. They must have some orderly structure to keep track of the medication, in which case I would recommend a pill box in this case.
Reassure the patient that there are methods to adhere to the medication around their lifestyle rather than the other way around. In addition, educate the patient about their disease state and reasons for taking their medication. A better understanding from the patient of their condition will most likely increase their compliance. Educate the family as well so they can provide moral support to the patient as well as adherence. Let the patient know how he can contact the pharmacist whenever the patient has a question about the medication.
The ideas posted by Chris and Jin are really great. Using our knowledge to try and find a better dosing regimen or even a different medication that is dosed more convenient is something I personally don't see being done that much. For the most part, the only time I see a pharmacist call for a change is for monetary reasons (which is not bad).
I just think that if we noticed a regimen of a medication dosed qid and there is another form that can be dosed bid or qd, we should keep that in mind when counseling. If we notice noncompliance issues, maybe changing the medication is the key.
We all have really great comments, and Chris is totally right that with all of these ideas, compliance issues should be something we are ready to always tackle.
Most people on chronic meds are on them improve their quality of life, and on the same note, these medications will improve mortality/extend their life longer than what it would be without taking the medicine. I think that is a concept patients may not understand - many see these regimens as a hindrance and a chore rather than an extension on life.
So far I've been using my Excel program to enter in the time that I took the medication. Biggest problem sometimes is I don't have the computer with me and I can't enter in the time that the medication was taken. This usually leads to either not entering the time or recounting the medication to see if I did take the medication. Time consuming.
ReplyDeleteThe best ways so far I have used to remember to take my medication is to line it up with something I normally do during the day. I've used breakfast, lunch, and dinner to help mostly but I still am having trouble.
ReplyDeleteI have been timing my regimen out with meals in a similar way to Derek. I try to take on with my 3 meals and 1 before bedtime. I have also been keeping the "medication" in my pocket and not my bag so that I will periodically stumble upon it and not forget.
ReplyDeleteLuckily I can take all of my tablets at once, so timing isn't even an issue for me and my warfarin 2.5 mg tablets. For the past few days I have just been taking them at school.. it seems just being here reminds me to do this assignment...my only problem seems to be keeping my medication in a safe spot not to get smashed. Jin your method seems like it requires too much effort and seems like its not real convenient. If you are really into the electronic method you could try an iphone/itouch or even a cellphone calendar?
ReplyDeleteAs I mentioned in question 1, I haven't really tried anything yet except for just will power to remember. This works for the morning and afternoon doses, but not the evening. I will report back about using my phone alarm at night to help remember the third dose and if this helps or not.
ReplyDeleteOn the first day of my regimen, my first dose was at 9am and I missed my second dose at 5pm. I remembered it at 7pm and took it immediately. This threw my schedule off by two hours and I would have to take my third dose at 3am. I decided to skip this third dose because I did not want to wake up in the middle of the night just to take my medication. I took a dose as soon as I woke up the next morning which was at 7am and decided that I would start my dosing schedule over. I used my phone to set alarms for 7am, 3pm and 11pm daily to remind myself to take the medication. I don’t think these times would be a problem especially when I have them set on my phone and I always have my phone with me. I associate the 3pm dose with ICARE because most of our ICARE classes start at 3pm. So far, so good.
ReplyDeleteI have multiple alarms on my phone set for every 6 hours so that I can take the medication. However, since I have to set my phone to silent during classes, I have regularly forgotten to take my next dose. It has been difficult to keep up with our daily class schedules and adhering to my medication regimen.
ReplyDeleteJin, I like your idea about using the Excel spreadsheet. I am usually always near my computer and it would definitely be more useful while I am in class and cannot hear my phone alarm. I think probably even sending an email to oneself (and marking it as unread) with the times that one must take their medications would be useful so it is always in your inbox. I am very "Type A" so this would probably catch my attention more than a spreadsheet.
ReplyDeleteIn regards to the use of spreadsheets, this may work for us as students since we are by a computer most of the time, but in reality this would probably not be an option for the general public. If I was trying to assist a patient on ways to maintain adherence, I really like the idea of cell phone alarms. Cell phones are a staple for most people and they are usually not very far from the person. The idea is kind of similar to those pill boxes with alarms on them as well.
ReplyDeleteSo far, my phone alarm has been working and I have been taking all of my doses. Shabana, you mentioned that you have your phone on silent during class and often miss the alarm. I am not sure how your phone works, but when I miss my alarm, it continues to go off every 5 minutes until I acknowledge it. Therefore, you could either keep your phone on the table so you can see it light up for the alarm during class...or you can just wait until after class and hopefully the alarm will be continuing to go off to remind you to take it as soon as you can. I don't think it is absolutely crucial that these medications be taken at their exact scheduled time. As long as they are plus or minus 30 min to an hour, I think it will still have the same effect and not cause too much damage.
ReplyDeleteHow do you think patients feel when he/she may have to take several medications throughout the day - all at different time intervals?
ReplyDeleteHow would you counsel or encourage a patient to be adherent, if he/she feels "controlled by medications"?
This comment has been removed by the author.
ReplyDeleteThe first thing I would check for this type of patient is if the number of doses can be reduced for any immediate release medications. Pharmacists have the resources to explore alternatives for a patient, whether it be a sustained release dosage form or just a higher strenth, and then present the findings to the doctor for approval. One sustained released tablet can easily replace 2 or more and I am sure adherence grows by leaps and bounds. I feel like this step could put most people's medications together at most or all points of the day.
ReplyDeleteI would also like to note that most of our classes entries demonstrate how many options are available to our patients to use as reminders for taking medication. Schedules, calendars, alarms, excel, meals, etc. were all used by this group alone. Knowing all of this, it should be possible for each of us to counsel someone on how to take their medications. If a person truly wants to be compliant, then we should definitely have an option that would help them out.
ReplyDeleteMy regimen isn't tough at all to keep up with. Every 12 hours for me is best at 10 and 10. I will usually be up for both these times. However, I agree, Sarah, that most of these aren't crucial to be given on the perfect schedule. With amoxicillin, I am seeking to keep a therapeutic concentration for a 7 day span... so there is an expectation of not missing doses. However, if I must take a dose early or late to keep from missing, it isn't that big of a deal. Some patients on amox are taking 4 doses per day, so there is some wiggle room in my regimen.
ReplyDeleteAs far as remembering, I haven't had much difficulty. I'll take a dose when I am getting ready in the morning, and I am regularly home and showering about the time I need to take the second dose. Some evenings I work until 11, so I catch up with a dose when I get home... rather than risk losing the medication or leaving it at work. Weekends are the tough period though, when I don't have "alone time" before my family wakes... so my morning routine is considerably different. At least I only have one weekend to take this medication, and it is near the end of my abx therapy.
In response to Dr. Clements's question, I can see how some crazy regimens might leave a patient anxious about going into the world without their medicines. Activities might run long and without adequate preparation, you might WANT to take the medication but not even have it available. Thanks Chris for pointing out some major points that might help these patients. When a patient is more compliant, their drugs will work more effectively and might actually save them in healthcare costs by keeping them healthier, even if the tablets are more expensive.
ReplyDeleteIf a patient feels controlled by their medications, it is important to discover what makes them feel this way. It might be as simple as counseling a patient to be more discreet about their insulin administration (children especially) or timing medications around a night-shift worker rather than assuming they operate like a day-shift worker. Medications are prescribed to help prolong enjoyment of life, not destroy it prematurely... but we must ask the right questions in hopes of coming to an appropriate answer.
Kyle, I definitely agree with you that we must ask the patient exactly why they feel confined by their medications in order to help them. We should find ways to fit the medication into the patient’s lifestyle instead of making the patient feel like they have to adjust their whole life around their medication. This means we have to take the time to talk to patients and find out what is important to them. I know that this is difficult to do in busy retail pharmacies and would be unrealistic to talk to every single patient who gets a prescription. However, if a pharmacist could dedicate a bit of their time to even one patient per day it would create a huge impact.
ReplyDeleteIf a patient has to take multiple medication at different times,the first option I would look at is the availability of drugs in the same class which might have a less frequent dosing regimen to make matters less complicated for the patient. They must have some orderly structure to keep track of the medication, in which case I would recommend a pill box in this case.
ReplyDeleteReassure the patient that there are methods to adhere to the medication around their lifestyle rather than the other way around. In addition, educate the patient about their disease state and reasons for taking their medication. A better understanding from the patient of their condition will most likely increase their compliance. Educate the family as well so they can provide moral support to the patient as well as adherence. Let the patient know how he can contact the pharmacist whenever the patient has a question about the medication.
The ideas posted by Chris and Jin are really great. Using our knowledge to try and find a better dosing regimen or even a different medication that is dosed more convenient is something I personally don't see being done that much. For the most part, the only time I see a pharmacist call for a change is for monetary reasons (which is not bad).
ReplyDeleteI just think that if we noticed a regimen of a medication dosed qid and there is another form that can be dosed bid or qd, we should keep that in mind when counseling. If we notice noncompliance issues, maybe changing the medication is the key.
We all have really great comments, and Chris is totally right that with all of these ideas, compliance issues should be something we are ready to always tackle.
Most people on chronic meds are on them improve their quality of life, and on the same note, these medications will improve mortality/extend their life longer than what it would be without taking the medicine. I think that is a concept patients may not understand - many see these regimens as a hindrance and a chore rather than an extension on life.
ReplyDelete