Adherence

Question 1

what is the definition of adherence?

Answer 1

the extent to which the patients behaviour matches agreed recommendations from the prescriber

Question 2

what is the definition fo compliance?

Answer 2

the extent to which the patient behaviour matches the prescribers recommendations

Question 3

why is compliance not used any more?

Answer 3

relegates the patient to a passive recipient of medical advice rather than someone involved in shared decision making

Question 4

what is shared decision making?

Answer 4

a collaborative process that involves the person and their healthcare professional working together to reach a joint decision about care

Question 5

what model can be used to help with shared decision making?

Answer 5

the revised three-talk model

Question 6

what is the three-talk model of shared decision making?

Answer 6

1 - team talk - work together to describe choices, offer support, ask about goals
2 - option talk - discuss alternatives
3 - decision talk - get to informed preference

Question 7

what is concordance?

Answer 7

the shared agreement between prescriber and patient regarding decisions which incorporates their respective view - the collaborative outcome of shared decision making

Question 8

what is initiation?

Answer 8

when the person starts their prescribed medication

Question 9

what is implimentation?

Answer 9

the extent to which the pt’s medicine taking behaviour aligns with the prescription

Question 10

what is presistence?

Answer 10

the length of time between taking the first and last dose

Question 11

what is discontinuation?

Answer 11

when the pt takes the last dose of medicine marking the end of therapy

Question 12

what 4 groups are more likely to report not being involved in their care?

Answer 12

people with dementia
people with hearing loss
16-35 y/o
>66 y/o

Question 13

what are 3 implications of non-adherence to the NHS?

Answer 13

Financial - wasted medicine
Can limit therapeutic benefit of medicines
can lead to increased demand at additional cost

Question 14

True/False - patients who adhere to treatment have better health outcomes?

Answer 14

True

Question 15

what is intentional non-adherence?

Answer 15

when the patient makes a conscious decision not to follow recommended treatments

Question 16

what is unintentional non-adherence?

Answer 16

the patient wants to follow treatemnt but is prevented by certain factors

e.g. - forgetting, lack of understanding, practical barriers

Question 17

what are the 5 domains of non-adherence?

Answer 17

Social and economic factors
Condition related factors
Health system/care team factors
Patient related factors
Therapy related factors

Question 18

what are 5 health system/care team factors for non-adherence?

Answer 18

Insufficient counselling
lack of community care
lack of follow up
long wait times
poor provision of information

Question 19

what are 4 patient related factors for non-adherence?

Answer 19

patient disagreement with necessity of treatment
fear of dependence
patient anxiety
low motivation

also visual hearing and cognitive impairment as well as swallowing problems and impaired mobility

Question 20

what are 6 therapy related factors for non-adherence?

Answer 20

complex regimens
immediacy of beneficial effects
adverse effects
duration of treamtment
polypharmacy
frequent changes to therapy

Question 21

what are 5 condition related factors for non-adherence?

Answer 21

level of disability
rate of progression
severity of illness
severity of symptoms
specific conditions - depression, anxiety, drug/alcohol misuse

Question 22

what are 6 ways to improve communication?

Answer 22

adapt consultation style
ask open questions
use communication aids
consider factors that may affect communication
encourage questions
use simple language

Question 23

what are 5 ways to increase patient involvement?

Answer 23

avoid non-verbal cues
avoid assumptions
Base decisions of benefits and risks
explain advantages and disadvantages of treatment
explain disease of condition clearly

Question 24

what information should be provided to patients about their medications?

Answer 24

adverse effects
duration of treatment
info about how to take
likely benefits
what to do if they get adverse effects
what to do if they miss a dose

Question 25

what are 3 objective ways to measure adherence?

Answer 25

measurement of levels in blood/urine
use of electronic monitoring devices
prescribing database - when prescription is filled ect

Question 26

what is subjective measure of adherence?

Answer 26

patient self reporting

Question 27

how do you ask about adherence?

Answer 27

avoid blame
clearly explain why you’re asking
state specific timeframe
ask about habits
use prescription records

Question 28

what are 9 interventions that can be used to increase adherence?

Answer 28

counselling
simplification of regimen
reminders
educational programs
support groups
family and psychological therapy
supervised self-monitoring
close follow up - telephone calls, home visits
rewards for success

Question 29

how can adverse effects be reported?

Answer 29

through yellow card scheme

Question 30

what are 2 schemes to help with prescription costs?

Answer 30

prescription pre-payment certificate - if get more than 11 prescriptions a year
NHS low income scheme - HC1 form submitted for HC2 (free) or HC3 (reduced) prescription charges

Question 31

what is the new medicines service?

Answer 31

pharmacy led intervention where patient is followed up 14 days and 1 month after new medication dispensed to promote adherence