Adherence in Dentistry

Question 1

What is adherence?

Answer 1

Patient’s ability and willingness to follow recommended health practices including maintaining these

Question 2

How high is nonadherence for medicines?

Answer 2

30-50%

Question 3

Name 2 umbrella terms of nonadherence?

Answer 3

1. Unintentional nonadherence

2. Intelligent nonadherence

Question 4

Name 3 types of nonadherence

Answer 4

1. Fulfilment
2. Non-Persistence
3. Non-Conforming

Question 5

What is fulfilment in terms of nonadherence?

Answer 5

Prescription is never filled or initiated by the patient

Question 6

What is non-persistence in terms of nonadherence?

Answer 6

A patient decided to stop taking medication on their own, usually due to miscommunication of the therapeutic plan

Question 7

What is non-conforming in terms of nonadherence?

Answer 7

Medication is not taken as prescribed e.g. skipping doses, taking incorrect doses

Question 8

Name 5 categories of risk factors related to nonadherence

Answer 8

1. Social and Economic
2. Health Care System
3. Condition Related
4. Therapy Related
5. Patient Related

Question 9

Describe 4 components of social and economic risk factors related to nonadherence

Answer 9

1. Limited language proficiency
2. Low health literacy
3. Homelessness
4. Medication cost / Lack of insurance

Question 10

Describe 4 components of health care system risk factors related to nonadherence

Answer 10

1. Patient-provider relationship
2. Long wait times
3. Lack of care continuity
4. Restricted formularies

Question 11

Describe 4 components of condition related risk factors related to nonadherence

Answer 11

1. Lack of symptoms
2. Severity of symptoms
3. Depression
4. Psychotic disorders

Question 12

Describe 4 components of therapy related risk factors related to nonadherence

Answer 12

1. Complexity of regimen
2. Duration of therapy
3. Frequent changes
4. Actual or perceived side effects

Question 13

Describe 4 components of patient related risk factors related to nonadherence

Answer 13

1. Visual, hearing or cognitive impairment
2. Knowledge about disease
3. Perceived susceptibility to disease
4. Motivation and confidence

Question 14

Describe Ley’s Model of Compliance

Answer 14

• Understanding and memory lead to satisfaction
• Understanding, memory and satisfaction all lead to compliance
• Compliance shifts to adherence which shifts to concordance

Question 15

Describe how health literacy can be a barrier to adherence

Answer 15

• Mismatch between patients’ health literacy skills and informational demands by provider
• Many patients have difficulty understanding information
• Patients forget up to 80% of what physicians tell them

Question 16

Describe the effects of low health literacy

Answer 16

• Lower knowledge, poor adherence, fewer preventative services and increased cost
• Barrier to effective prevention and treatment

Question 17

Name 3 factors relating to the dentist which can influence nonadherence

Answer 17

1. Communication skills
2. Personal beliefs
3. Personal knowledge of patient

Question 18

Name 4 problems associated with diabetes

Answer 18

1. Hypoglycaemia
2. Circulation problems
3. Heart problems
4. Vision problems

Question 19

Name 4 reasons why a person with diabetes may not adhere to doctor’s advice

Answer 19

1. Embarrassment of testing and injecting in public
2. Lack of family / social support
3. Restriction on normal daily routine
4. Feeling different by following an alternative diet

Question 20

Name 1 reason why there may be poor patient adherence in dentistry in terms of reward

Answer 20

Patients are asked to act to avoid disease in the future and immediate benefit can be hard to see

Question 21

Describe 4 ways which nonadherence in dentistry can have health and financial implications

Answer 21

1. Missing appointments
2. Failing to follow oral health advice
3. Failing to change daily routine
4. Not wearing appliances

Question 22

Name 5 parental views on factors influencing tooth brushing in children from Duijster D et al., study in 2015

Answer 22

1. Parenting strategies
2. Parental monitoring and supervision
3. Parental knowledge
4. Perceived importance
5. Tooth brushing routines

Question 23

Name 5 parental views on factors influencing children’s consumption of sugary foods and drinks from Duijster D et al., study in 2015

Answer 23

1. Affordability of food
2. Commercials and television
3. Social environment
4. Dietary routines
5. Parental control on diet at home

Question 24

How does adherence relate to treatment of periodontal disease?

Answer 24

• Treatment is based around effective self care
• Success dependent on information and motivation
• Behaviour change required

Question 25

Suggest 2 reasons a person may not wear a retainer to improve long term success in orthodontic treatment

Answer 25

1. Lack of immediate reward 2. May not be involved in decision making (young child) 3. Laziness 4. Comfort levels 5. Lack of knowledge of the benefits

Question 26

Suggest 4 ways to improve information giving in dentistry

Answer 26

1. Use of written information a patient can take away 2. Proper in surgery e.g. x-rays / models 3. Frequent summaries and get patient feedback 4. Give most important information first and last

Question 27

What is the main 2 methods of person-centred strategies for improving adherence?

Answer 27

1. Teach back | 2. Ask 3

Question 28

What does DIIF stand for in terms of improving adherence?

Answer 28

- Discuss (difficulties and benefits) - Improve (improve communication) - Include (written information where possible) - Follow (follow up)