Communication 2 - Adherence to Therapy Flashcards
(19 cards)
Define compliance:
The extent to which a person’s behaviour (in terms of taking medication, following diets or implementing other lifestyle
changes) coincides with medication or health advice
Define adherance:
The extent to which a person’s behaviour- taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider
- refers to the patient following the prescribers instructions
Define persistence
A measure of duration of treatment; how long does the person follow the therapy
If an Individual is non-adherant then…
Diagram in Google Docs
They will not start the first dose (non-initiation), they won’t take the meds regularly (non-implementation; forgetting to take it, too lazy, other responsibilities) and they will stop earlier than when they should do (non-persistence) - i.e. not reach the end of course
If an Individual is adherant then…
Diagram in Google Docs
He will take the first dose (initiation), he will take the medication regularly on a day-to-day basis (implementation), he will reach the end of course (persistence)
Define concordance
- Concordance in healthcare refers to a mutual agreement between a healthcare professional (like a prescriber) and a patient about the patient’s treatment plan.
- It emphasizes respect for the patient’s beliefs, preferences, and decisions, and involves shared decision-making rather than simply following medical instructions.
How can pharmacists promote adherance in patients
- Understand how to motivate the patient (e.g. convincing them that the medication has benefits. Inform them that by not taking the meds now it will increase the severity of complications in the future - further decrease in health and wellbeing.
- Give them knowledge on how to take the medications on a daily basis
Assumption: doctor has prescribed the correct treatment for patient.
As as pharmacist how can we improve adherance to therapy in patients
- Establishing concordance with patients and ensuring a patient-centred approach to care
- Giving approapriate information to the patient
- Counselling and patient education
- Monitoring of effectiveness of therapy
- Provision of behavioral strategies to assist their adherance (will increase competency in patient)
List the facts associated with extent of non-adherance.
1.51% took 60% of analgesic dose for cancer pain
2. A descriptive study of self-reported adherence among oncology outpatients - 41% of patients were adherent to their prescribed analgesic regimen
3. Self-reported adherence to analgesia for cancer pain- 51% reported lower levels of adherence; only 8.9% of patients were in the high–analgesic adherence group
4. **70%–90% **of cancer patients experience pain (final stages
of cancer), but non-adherence rates ranging from 20%–33%
Discuss the consequences of non-adherance
Poor adherance –> poor health outcomes –> increased use of the health-care system –> increased healthcare costs –> increased costs for the patients and public
Discuss. the advantages of patient adherance
- Improves patient health outcomes
- reduces morbidity and mortality
- reduces costs associated with hospital admissions, alternative drug regimens and healthcare professional costs
Describe the classification of non-adherance
- 2 main types: Primary and Secondary
- Primary: People don’t get their medication dispensed from the pharmacy
- Secondary: People who get their medication dispensed however they dont take the initial dose or delay it, non-implemenetation, non-persistence (e.g. don’t reach the end of the course)
- Under secondary non-adherance: Intentional and non-intentional
1. Intentional: I know I am not taking this med and I don’t want to take it
2. Non-intentional: overdoser, underdoser, random, take a break from medication, time-dependant, previst adherant, symptom dependant
List the factors that contribute to non-adherance in patients
- Medication has major side effects
- Large cost of meds
- difficulty taking meds (e.g. popping it out from blister pack, using the asthma puffer,
- Polypharmacy (are on several medications) due to multiple diseases
- Language difficulties
- Literacy or health literacy issues
- Memory issues
- Access to Dr or pharmacist
List the common reasons why healthcare professionals contribute to poor adherance in patients
- Lack of knowledge around adherance
- Lack of clinical knowledge around the medication
- Poor attitude around the importance of medication
- Poor communication skills
- Lack of time
- Working in the dispensary and your a single pharmacist - more responsibilities on your shoulders - very busy - no time to communicate efficiently
- Inability to educate the patient
List direct adherance measures
- Blood levels
- Direct observation
- Biological markers
List in-direct adherance measures
- Patient self-reports
- Pill counts
- Prescription repeat collection
- Clinical response
- Electronic medication monitors (eg MEMS)
- Patient diaries
List the strategies to improve adherance
- Informational
- Behavioural
- Social support
- Combination of the above strategies
Discuss how informational strategies can improve adherance
- Education
- inform patient what the medication does, how to take it, how the medication will benefit them, inform on side effects and teach them how to deal with these side effects
- inform about monitoring strategies to see if the medication is working or not: - if it is working - can improve motivation - improves adherance
E.g. sore throat - did the pain go away
- blood pressure - measuring it by a machine either at home or with a doctor
- cholesterol - need to take blood tests
Discuss how behavioural strategies can improve adherance.
- Dosage simplication: Easy to take a medication that is 1 times a day or 2 times a day compared to 4 times a day and is in simple packaging
- Assessment of medicine use with direct feedback to patient
- Specialised packaging
- Reminder mechanisms
