Case Study: Interprofessional Collaborative Care

Interprofessional Collaborative Care for Improving Medication Adherence
Problem
A minor with asthma experiences difficulty adhering to controlling medication. Noncompliance is common, as Zullig et al. (2013) state that on average 50% of medications for chronic conditions are not taken as prescribed (p. 2611). Patient was recently hospitalized for an asthma attack that could not be controlled with rescue medications; while in the hospital, he indicated that he was not taking his prescription. He does not refill prescriptions and does not attend follow-up appointments. His family has low socioeconomic status; his mother often works and patient shows evidence of financial insecurity when communicating with his pharmacist. Zullig et al. (2013) indicate that medication costs that are “prohibitively expensive

for the patient” are part of a multifactorial problem in adherence (p. 2611). Patient is often dependent upon his brother for transportation; he may be unable to schedule and attend regular appointments.
During the patient’s appointments, he is overlooked by his mother and his healthcare providers because he is a minor. While he may have insight into his care needs, he is unable to voice his concerns.
Cohesive treatment between healthcare professionals is absent. Patient’s care providers do not emphasize adherence, and no resources are provided for financial aid.

Consequences
According to Chappell (2015), nonadherence can significantly affect patient conditions, especially pediatric patients.

This patient’s condition continually worsens, to the degree of needing emergency care, because he does not take his medication.
Solutions
Ideal interprofessional collaboration with the patient’s team involves forming a unified plan to educate him and his mother on the importance of adherence. The care team needs to communicate with the patient’s mother to solve financial barriers in obtaining medications. Additionally, the team needs to explain to the patient and his family the importance of attending appointments, to allow the care team to monitor his condition, adherence, and treatment.
Lack of support in patient healthcare teams inhibits compliance. The team must ensure the patient and family understand risks associated with untreated asthma; they need to encourage the patient and hold him responsible for taking his medication. Patient must become involved during appointments, as he currently feels ignored. If he is given the care and attention he needs, he will see the importance of taking his medications to prevent

exacerbations..
Monthly meetings involving the patient’s entire care team would keep each member updated in monitoring his condition. His worsening condition can be seen in all areas care, even dentistry. Incorporating additional health professions, such as occupational therapy and social work, would make patient care more comprehensive. Occupational therapy can provide medication management strategies; financial and transportation issues may be addressed by a social worker. A policy change at the local health system level, encouraging more holistic treatment of patients and regular meetings, would keep care providers updated on patient treatment and adherence. For example, a study conducted by Poivret et al. (2016) showed collaboration between doctor and pharmacist had a positive effect on adherence, as 75% of patients continued their treatment at 2 years. A policy change to increase patient appointments per year, while reducing patient costs, would also significantly increase patient outcomes.
To address the financial barrier issue nationwide, with a policy change in insurance based on financial status, more patients would have access to medication, therefore increasing patient adherence. This policy would allow dependent, minor patients to receive free medications if they qualify based on their parents’ financial status. This allows for easier care of patients, and one less issue to address as an interprofessional team, which allows better overall care to each patient.

References
Chappell, F. (2015). Medication adherence in children remains a challenge. Prescriber, 26(12),
31-34.
Poivret, D., Wilcke, C., Noirez, V., & Goetz, C. (2016). AB0776 Improving Adherence To
Osteoporosis Treatment by Promoting Patient Involvement in Physician/pharmacists Cooperation. Annals of the Rheumatic Diseases, 75(2).
Zullig, L. L., Peterson, E. D., & Bosworth, H. B. (2013). Ingredients of Successful Interventions to Improve Medication Adherence. JAMA, 310(24), 2611-2612.