Short Version: Why Patients Stop Taking Their Controller Medications

-Many stop taking their medications when they don't show symptoms.

-Compliance implies passive and disinterested. Adherence implies an activated patient who willingly accepts their role and responsibility. So let's stop calling it compliance and start calling it adherence.

-Non-adherence increases morbidity, mortality, and healthcare costs.

-Most common reasons for Intentional Non-adherence:
  1. Concerns about adverse effects - 65% of new prescriptions for inhaled corticosteroids are not refilled. Inhalation route of steroid administration does not necessarily equate to HPA axis suppression (i.e., growth retardation) or bone density issues.
  2. Medications are too expensive - Many pharmaceutical firms offer rebates or special pricing for low income patients.
  3. Not really that sick - Denial is a problem with asymptomatic patients. Conversation should be on the difference between effective long-term symptom control and a 100% cure.
  4. Not wanting to get “hooked” - An counter to this perception would be to stress that the eventual goal is to achieve an improved overall quality of life.
  5. Medications no longer work - When a regimen of inhaled corticosteroids is successful, subsequent doses may not be perceived as having any impact, as their role is now more preventative.
  6. To gain attention - It is important that parents realize, especially with asthma, the possibility a recurrence of symptoms may indeed be the direct result of the child willfully deciding not taking their medications as directed. 
-Respiratory therapists possess all of the skills, attributes and talents needed to help foster sustained adherence.


The Five Things I Always Carry In My Pocket As A RT

1 Pen
Kind of obvious. I don't buy pens anymore because I always lose them. The best pens are the free ones.

2. Report Sheet AKA The Brain. 
Because It's really difficult to remember more than 6 patients and all their settings. 

3. Scissors 
The ones with the smooth edges are better than the sharp OR scissors. I have stabbed myself in the butt while sitting down. Never again. Scissors are just so useful. Where I work not all of the patients rooms have scissors stocked in their carts.

4. Pen Light 
I work night shift. It's essential to use a pen light to check ETT tube placements, meds, flow meter settings and etc. without turning on all the lights in the room. I see some coworkers have used their phones to look for things in the dark. It just doesn't look as professional / bad ass as a pen light.

5. Sharpie Marker
Labeling drugs and stuff that needs to be replaced.

Other stuff that I carry on my body:

You're not a respiratory therapist without one. 

Because half the clocks at the hospital need new batteries or are set to the wrong time. 

Other stuff I would like to carry but I don't have space and I'm not going to wear a fanny pack:

22mm adapter
It's a fact: 22mm adapter > 18mm adapter

ETT tape
I always have trouble finding good tape. I can't stuff it in my pocket because it always collects lint and then it looks gross.

Adhesive remover
Because it's mean to rip tape off a kids face without it. 

Clamps help me break adapters apart when our equipment gets crusted with salt.