Question

1.Medication non-adherence among patients with hypertension is a major pharmaceutical care challenge. How can you as pharmacist rely on the classical conditioning learning approach to improve adherence in a 50-year old male patient with hypertension who has consistently shown poor adherence behavior to his anti hypertensive medication?

2.Community pharmacists contribute to health education and health promotion. List and briefly explain 4 constraints that community pharmacist may face in contributing to health education and health promotion.

Answer 1

1. Taking the prescribed medications on time is essential for controlling chronic diseases, treating temporary health conditions and also the overall well being of a person. Non-adherance to medication will not give the desired results in patients. Adherance to medication is influenced by a number of issues like cost of medication, dosing frequency, side effects, how the medication is to be taken and also patient beliefs, culture, etc.

In the above case, to influence the patient, one would have to target the cause of non-adherance to medication. There could be several reasons for the patient not taking medicines on time and regularly, like, the patient might be of the opinion that he can control his hypertension by diet and exercise. Or he might be of the opinion that the medicine will have adverse effects on other organs, and that his body might get addicted to the medication. To influence him, the first target should be to make him aware that what damages a prolonged high blood pressure can bring to his heart and other important organs like the kidneys and the brain. The pharmasist, acting as a counsellor, will need to explain to him that how neglecting the medicine can lead to a worsening of the condition leading to stroke, heart attack, kidney failure, and paralysis. Continued high blood pressure will put a huge strain on all other body organs, can cause hemorrhage of tiny blood capillaries in the brain, leading to coma or other kinds of vegetative states. He will need to be told that hypertension is a manageable condition and does not interfere with normal life if it is under control.

So, to influence and councel the patient, he will have to be explained what health complications he is putting himself into by neglecting his medicines.

2. Some constraints faced by community pharmacists face during health education and awareness are -

a] Financial constraints - Sometimes the cost of medicines and the treatments involved is such that people of the lower income group are not able to afford. Although, almost every country in the world has some health benefit schemes for its citizens, but many a times there is a limit to services provided. People forgo their medicines if they find it difficult to afford it.

b] Religious beliefs - In some countries certain religious believes stop people from taking medicines. Like, if the people believe that the medicine composition includes some content which is not allowed in their religion, they refuse to take it. In some parts of the world, people would not give polio drops to young children because they believe it contains something which will make their children sterile.

c] Administration of medicine - The way the medicine is administered also determines if the patient will take the dose or not. For example, if it is to be taken orally, it is easier, but if the medicine has to be injected, then the patient may try to avoid it. If the patients have to go to the health-care center for medicine to be administered, they might skip it on some days.

d] Lack of awareness about the seriousness of their medical condition - Many patients are unaware as to what their disease can lead them to, if neglected. So, they have to be councelled on the possible health complication they may have to face in future if they do not take their medicines regularly and on time.

It is a tough job for the community pharmacists to convince and monitor people to take care of their own health. Many times they have to face the hostility of the patients too, who think that the pharmacist is trying to unnecessarily scare them!