Adherence and Consultation Flashcards

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1
Q

At each stage of dealing with an illness, there are factors which interfere with this process- such as:

A
  • “Am I ill? Is that a symptom?”
  • “Is it worth bothering a doctor about?”
  • “Will the doctor see me?”
  • “I’m just getting old – I’m expected to have health problems!”
  • “There are others more needy than me; I’m not that ill”
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2
Q

Initiating consultation is a ——— decision

A

Initiating consultation is a behavioural decision

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3
Q

Outline the ‘integrated behaviour change model for physical activity’ by Hagger & Chatzisarantis (2014).

A
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4
Q

Give examples of patterns of consultation behaviours

A
  • Variation between individuals in consultation behaviour
  • Some consult for minor ailments
  • Others rarely consult: the “Clinical Iceberg” effect
  • Doctors only see the tip of the iceberg
  • Structural factors are also important
  • Inability to get a GP appointment; postcode lottery
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5
Q

What were the general findings from the Cowling et al. (2014). Access to general practice and visits to A&E from National Patient Survey data

A
  • 11% increase in “unplanned” attendances at A&E, 2008/9 – 2012/13
  • 5.77 million A&E attendances were the result of patient not being able to access general practice
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6
Q

Why is early consultation important

A
  • Early diagnosis helps with uncertainty (of symptoms)
  • Better management of care (planning); avoidance of risks (vehicle accidents, medication errors)
    • And treatment
  • Early access to medical and non-medical (lifestyle interventions) treatment
  • Alzheimer’s Disease International (2011): >50% cases are not recognised in primary care (GPs)
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7
Q

What % of new cancer diagnoses are made following A&E visit (i.e., quite late)

A

25%

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8
Q

What are the implications of: 25% of cancer diagnosis being made in A&E and 10% of people with cancer see GP >5 times before getting a diagnosis

A
  • Not everyone takes up screening opportunities
  • Doctors may be ill-prepared for identifying some symptoms
  • Potentially more severe symptoms and progression of disease = worse outcomes
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9
Q

The patient has the disease and the test correctly identifies it

A

True Positive

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10
Q

The patient does not have the disease and the test correctly identifies it

A

True negative

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11
Q

The patient does not have the disease but the test says they do

A

False positive

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12
Q

The patient has the disease but the test says they do not

A

False negative

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13
Q

What is an individual’s perception of a symptom based upon?

A
  • Personality factors
  • Demographics (age, gender, SES, ethnicity etc.)
  • Mood / cognition
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14
Q

The social contexts affects our perceptions of ‘symptoms’

Describe what Levine and Reicher (1996) found: PE vs. FEMALE identity and perceptions of facial scars

A

More worried about facial scars when social identity was shifted to female from course studied in undergraduates

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15
Q

Describe the findings of Haslam et al. (2012)- affect of self-categorising as old vs young

A
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16
Q

Why might a elf-categorization as “older” led to poorer performance on all tests

A

A “stereotype threat” effect

  • Effect interacted with aging expectations
  • Those expecting general decline reported poorer performance on cognitive ability tests (and met criteria for detecting dementia)
  • Those expecting memory decline performed worse on memory tests
  • Highlights the importance of social identity (self-categorization) in symptom perception (and “role” performance)
17
Q

What did Porter et al. (2004) find regardining illness consulation

A
  • 50-75% of UK population experience ill-health symptoms over a 2-week period
  • But only 1/3 of these consult a GP
  • Others self-medicate, or live with symptoms (which may or may not pass)
  • Illness cognitions are an important consideration
18
Q

What are the 5 steps of an illness cognition

A
  1. Identification/classification (what is it?)
  2. Timeline (how long will it last?)
  3. Causes (what caused it?)
  4. Consequences (how will is affect my life?)
  5. Controllability (can I manage myself or do I need help?)
19
Q

What factors could interfere with consulation

A
  • Whether seeking help will get in the way of work / disrupt normal life
  • Whether seeking help will get in the way of social life
  • Anticipation of costs/benefits of going to the doctor
  • Social pressure not to seek help – public health campaigns
  • Past experiences of symptoms
20
Q

What is the problem associated with social stigma

A
  • Some illnesses, especially mental health, are routinely stigmatised
    • Expecting stigma can inhibit help-seeking
    • Encourages patients to hide symptoms
    • 1/3 of patients with depression never seek help
  • A threat to “healthy” identity–> denial of symptoms (Farmer et al., 2012)
21
Q

What does this graph describe

A

Decision to consult not always straightforward and takes time.

We tend to seek help when symptoms are at their peak – and may be in decline

22
Q

Describe the Stanley Milgram (1963) experiment

A
  • “Learning experiment”: participant (always the teacher) and a learner (confederate)
    • Teacher had to ask learner questions
    • “Electric shock” administered for each incorrect answer
    • Intensity of shock increased with each administration
    • Maximum shock = 450 volts
  • None of the participants said they would administer a fatal shock
    • 65% of participants obeyed the teacher (gave fatal 450v shock)
  • CONCLUSION: people do a lot when compelled to do so, especially by authority figures
23
Q

What % of prescriptions are adhered to?

A
  • 920 million prescriptions in 2010 (2.5M per day)
  • Adherence is low: 40-55% (Ley, 1997)
    • Accounts for >10% of hospital admissions
24
Q

Give 2 types of compliance failure

A
  • Delay in (re-)seeking help
  • Failure to follow-up (breaking appointments)
  • Failure to follow Dr’s instructions
  • Incorrect dose or at wrong times
  • Non-completion of course
25
Q

Why is social identity important

A
  • Group membership (and identities) give us meaning
  • A “lens” for understanding the world
  • Strong set of norms guiding cognition and behaviour
26
Q

Define social identity

A

The group dynamics that shape other intergroup interactions also influence clinical interactions – and outcomes

27
Q

How can social identity affect adherence

A
  • Social identity may affect understanding, interpretation, memory for advice, and patient satisfaction (with consultation)
    • this may impact adherence
28
Q

How might we measure adherence?

A
  • Accelerometers
  • Diaries/log books
  • Attendance at rehab classes
  • Observation
  • Self-report questionnaires
29
Q
A