Understanding reasons for nonadherence including patient factors (such as poor health literacy, perceived lack of effect, depression, social isolation, cognitive and physical impairment), medical condition (polypharmacy due to multiple comorbidities), therapy (frequency of dosing, side effects), socioeconomics (out-of-pocket cost, difficult access to pharmacy), and health system (poor communication, silos of care, no automatic refills).Adherence: Improving adherence involves:. Team-based care is probably the most effective approach team-based care by definition is “delivery of health services to individuals, families, and/or their communities by at least two health care providers who work collaboratively with patients and their caregivers, in concordance with patient preference, to achieve shared goals within and across settings.”.More than 50% of the HF Medicare patients have four or more noncardiovascular comorbidities and more than 25% have six or more-raising the risk of inefficiencies of care delivery, miscommunication, potential drug-drug interactions and drug-disease interactions, and missed opportunities to achieve optimal outcomes.P: Prognostic medication progressive intolerance or down-titration of guideline-directed medical therapy ).L: Low systolic BP ≤90, high heart rate. N: New York Heart Association (NYHA) class IIIB/IV or persistently elevated natriuretic peptides.
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