According to summary results of the 2016 by-census conducted by the Hong Kong Census and Statistics Department (C&SD), the median age in the city has skyrocketed to 43.4 last year. A decade ago, the number was just 39.6.

Based on the statistics, the population aged more than 65 years is expected to double by 2036. The rapid growth of the population has caught the public’s attention on their health needs. Studies have pointed out 74% of the elderly in Hong Kong suffer from chronic diseases such as hypertension, diabetes, asthma and cancer. Throughout the long journey of chronic disease management, common medication problems such as polypharmacy and medication adherence are issues that healthcare professionals should take note.

Poor medication adherence leads to poor treatment outcomes and jets up healthcare costs

Specifically, medication non-adherence has long been a thorn in the physician’s side. It is a multi-factorial problem and varies from patient to patient. A study published in May 2016 recruited 2,445 subjects with an average age of 65.3 years in Hong Kong. Results showed that as many as 46.6% of hypertensive patients had poor medication adherence. Additionally, hypertensive elderly patients suffering from multiple long-term conditions were found to bear higher risk of medication non-adherence. Other factors such as mental state (depression), negative beliefs, lack of social support and poor socioeconomic status have also been linked to increased medication non-adherence.

Poor medication adherence leads to poor treatment outcomes. This is supported by evidence in a study published in JAMA where an analysis of 11,532 diabetic patients found that non-adherent patient were 1.58 times more likely to be hospitalised (for any reason) and were 1.81 times more likely to suffer from all causes of mortality.

Apart from patient outcomes, cost is another issue. According to estimates from the Centres of Disease Control and Prevention (CDC), drug-related problems such as taking medication at the wrong time, dose or frequency places an additional USD100 – 289 billion on already staggering healthcare costs.

Is prescribing medications with pictures the solution to medication non-adherence?

To tackle medication non-adherence in elderly patients, researchers from the Chinese University of Hong Kong (CUHK) came up with a simple yet ingenious solution – including pictograms on all written medical information.

In a study examining medical information comprehension, they discovered elderly participants favoured pictures in addition to the plain text on the medicine labels, especially for participants with a lower education level, foreign visitors and the visually impaired.

In contrast, when spoken instructions were given on how to take medications for multiple drug therapies, only about 20 – 60% of the instructions is remembered.
"People with vision problems or difficulties comprehending basic written information, for example, will be able to better understand their medication needs, which will help their health and support their independence," said Dr Annie Ng, lead author of the study.

Adherence needs to be reinforced in many dimensions

The World Health Organisation (WHO) proposed a model of the ‘Five Dimensions of Adherence’. They include factors pertaining to the individual condition, the patient, therapy related factors, socio-economic situations and health care provider related factors.

The Five Dimensions of Adherence. (Source: WHO)
The Five Dimensions of Adherence. (Source: WHO)

WHO proposes that interventions have failed in the past due to the reliance on tackling just one of the factors. It is common for the factors to influence one another. It is good practice for physicians to adopt a multifaceted approach when assessing patients for medication adherence. MIMS

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