Lecture 19: Adherence to Treatment Flashcards
Why does adherence matter?
- Treatment efficacy (partial supplementation, constantly taking sub-optimal doses of treatment) (and ultimately leading to greater longterm cost)
- Cost of wasted medications
adherence and efficacy vs. adherence and cost
What are ways of personalising adherence?
Symptom driven behaviour - go to doctor so check symptoms
increase effort = decreased adherence (lazy)
decrease pleasant = decreased adherence
What are some variations in adherence amongst domains?
lifestyle changes = 80% drop out
medication adherence typically higher
Increased adherence = when increased RISK if non-adhere
if can SEE the benefit and the benefit is MORE IMMEDIATELY seen then there is increased adherence
e.g. Asthmatic taking a steroid/bronchodilator > changing lifestyle and getting fitter
What is creative Non-adherence?
Intelligent non-adherence
- Altering dosage (pill splitting)
- retain medication for RESUSE amongst family members
- SUPPLEMENTING with OTHER treatments
- DOUBLE dosing
- most of the time Creative/Intelligent Non-adherene is due to patient being UNABLE to Tell Whether the TREATMENT IS WORKING???
What is it essential that clinicians distinguish between in relation to adherence, and its historical occurrence?
NON-responsive
vs
NON-adherent
-historically physicians have ASCRIBED non-adherence to patients with Un-cooperative personalities “bad people”, which ISN’T HELPFUL, as just makes the patient’s feel Judged
-cant make the patient feel JUDGED- if they feel judged they won’t tell you and it is Less effective
- need to crease an environment where patients will tell the truth
-have to be wary of -SELF REPORT and OVERESTIMATION/INFLATED ESTIMATES
What are the typical predictors of non-adherence?
- Treatment characteristics
-DURATION of treatment (lower adherence for chronic)
- FREQUENCY of medication/CHANGE
- COMPLEXITY of medication
- STORAGE/perishability
- INTERFERENCE with lifestyle
- SIDEFFECTS - Practical considerations
travel times/ locations, travel, medication costs - Demographic characteristics
-extremes of age
-minority status - Psychosocial characteristics
-LARGER effect than demographics (age) - Social Network factors. ((better predictor and MORE MALLEABLE)(people with greater social support are more malleable) (practical>emotional)
-lots of other demands all impacting
-practical and emotional support
-family cohesiveness or conflict
-marital status - Cognitive Factors
-risk and benefit beliefs and estimations
-health locus of control
-knowledge
-illness belief (fatalism)
- beliefs and medication - Side effects
-form of SYMPTOMOLOGY
-can be ascribed to medication
-serious treatment = serious side effects
more serious side effects= decreased adherence - Affective and regulatory factors
-DEPRESSION is the BEST PSYCOLOGICAL PREDICTOR of NON-ADHERENCE
What is a side effect?
Unintended consequence of taking a treatment
Almost all treatments have side effects
What are the affective and regulatory factors which are predictors of non-adherence?
DEPRESSION
-depression is the BEST PSYCHOLOGICAL PREDICTOR of non-adherence
ANXIETY also has a variable linke to adherence
Stress.
Disgust
-complexity of treatments and person’s social environment are good things to looks of to help you get into space to understand WHY the person is behaving in the way they are
What is disgust?
EVOLVED characteristic
is DERIVES non-adherence or “Health Threats”
Disgust has facilitated the adaptation of health threats
disgust impacts emotional, physiological, expressive, social and behavioural responses,
OVERALL: disgusts CORE function is to promote both IMMEDIATE and ANTICIPATORY ADAPTIVE RESPONSES to certain classes so stimuli
Immediate disgust: Physical protective/ejection type movements
Anticipatory disgust: predominantly AVOIDANT/protective behaviours
What are you immediate responses to disgust?
PHYSICAL protective/EJECTION type movements
What are your anticipatory responses to disgust?
Predominantly AVOIDANT/protective behaviours
What are the elicitors of disgust?
- violations of BODYB ENVELOPE
- exposed to a BODILY FLUID
- ROTTEN FOOD
- CONTAMINATION threats
- ABERRANT SEXUALITY
What is adherence like in relation to a chronic disease such as diabetes?
diabetes wide spread
impair carb, fat and protein breakdown
due to insufficient insulin release
urination frequently, dry mouth, irregular periods, slow healing, itching and drowsiness, pain/cramps in limbs
diabetes requires TIGHT ADHERENCE to CONTROLLING GLUCOSE LEVELS
=requires a change in lifestyle
=requires a lot of effort
=decreased adherence
Diabetes non-adherence is a SYSTEMIC problems
-patients are more worried about ACUTE events (more worried about hyperglycaemia)
What are the 6c classes of interventions which might increase adherence to diabetes managements (fix the systemic diabetes non-adherence)?
- DEMOGRAPHICS
- diabetes is associated with age, trade offs, comobidities - INSTITUTIONAL
- centralised reminder processes: automatic text reminders - Physician related
- need to get the patient on board. non-hostile environment. Adherences has GREATER chance when GOALS ARE SHARED between clinician and patient. clinician needs to be MORE SALIENT (behave in a way that they think will give a better outcome) - Technological
- alarms, electronics (glucose apps),ease of monitoring - Cognitive: Knowledge, people constantly making their own Subjective opinions on their own experiences. Clinician needs to gain insight on the patient’s c
How does a clinician need to behave, in relation to non-adherence especially?
be MORE SALIENT
-at in a way that they think will give them a better outcome with increased patient adherence
