Adherence Flashcards
Define compliance
To do what the doctor orders
Define adherence
When the patients behaviour coincides with the clinical prescription
Define Concordance
The prescriber and patient negotiate as equals to agree a plan of treatment
Agreement between patient and health care professional that respects the beliefs and wishes of the patient in determining whether when and how medicines are to be taken
Define ways of measuring adherence
Direct methods
- measure drug concentration in body fluids
- observation
Indirect methods
- tablet counts
- electronic monitors
- interview patients
- dispensing records
Describe causes of intense adherence
A
Describe cause of unintentional adherence
- take too much medicine
- poor understanding
- take too little (or no) medicine
- forget
- access
- poor understanding
- unable to use
- can’t afford
Discuss strategies for improving adherence
Simplify dosage regimen
Use combination products
- co-cadamol - contains codeine & paracetamol
- co-amilozide - contains amiloride &
hydrochlorothiazide
Change formulation - use modified release products
- diclofenac 25mg three times a day
- 75mg SR - take one daily
Change drug - to once daily drug
- captoptil - three times a day, ramipril - once daily
Describe factors that can affect non adherence
- dosage frequency
- length of treatment
- nature of the disease
Understand that lay beliefs may play a part in a patient adherence
A
Discuss how patients and health professionals can achieve concordance
- Explore the patients view regarding:
- condition and treatment:
- dont assume a medicine is desired
- ask the patient what kind of treatment they would prefer
- establish the patients general attitude to medicines
- determine whether social context will affect adherence (e.g work, leisure)
- condition and treatment:
- Ensure the patient:
- understands the purpose, benefits & risks of treatment
- is able to comply (clear instructions, simple regimen, appropriately trained etc
Hawthorne effect
Comes from factories
Wanted to see if improving the working conditions for the workers will improve the work . Which it did as productivity increased however when changing the conditions back to the way the were, it was still increased. They found that when people were being looked at (being measured) they worked harder.
Intentional non-adherence
Qualitative study patients ideas about medicines
Theme 1 - properties of medicine
-e.g. i dont like artificial things, antibiotics stop the bodies immune system from working properly, drug deal with symptoms not cause, drugs are dangerous and addictive
Theme 2 - orientation to medicines
Eg i prefer not to take medicines if i can help it, i try to find a chemist where they wont recognise me, i have never been fond of medicines
Theme 3- Actual use of medicines
Eg non compliant, if im not getting symptoms then i stop taking them even though i am supposed to continually take them, if had gangrene then i would resirt to antibiotics, last week i took an antihistamine for the first time in years as i had an important presentation to make
Who are non adherent patients
There is no clear link between adherence and Age Gender Social class Educational status
- most patients are non adherent at some point
The disability discrimination act 1995
If the pharmacy had determined that a patient has a disability,
ie has a physical or mental impairment which has a substantial and long term adverse effect on his ability to carry out normal day to day activities
- then reasonal adjustment should be made for the disabled person when dispensing
The DDA 1995
Invovle the provision of Large print labels Easy open containers Medication reminder chart Multi-compartment compliance aid Talking labels
