HealthPsych Session 8 Flashcards Preview

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Flashcards in HealthPsych Session 8 Deck (26):
1

What is adherence?

Extent to which pt behaviour coincides with medical advice

2

Is non-adherence the norm, even in conditions where it could prove fatal?

Yes

3

What are the outcomes of non-adherence?

Impact on pt's health
Financial implications of wasted drugs, consultations etc

4

What percentage of pts with chronic illnesses are non-adherent?

50%

5

In what type of treatment regime are low adherence rates typically seen?

Those that include lifestyle changes

6

Which diseases have the highest rates of adherence?

HIV
Arthritis
GI disorders
Cancers

7

Which diseases have the highest rates of non-adherence?

Pulmonary disease
Diabetes
Sleep disorders

8

Which could have a greater impact on improving population health: improving adherence or improvement in specific medical Tx?

Improving adherence

9

What are the problems with measuring adherence?

Definition of adherence - do you have to take prescription exactly as prescribed for it to be effective?
Tx over a period of time so when best to assess?
Lack of consistency in measures
Difficulty of comparison of studies between different conditions with different Tx

10

What direct measures can be used to measure adherence?

Urine/blood test
Observation

11

What are the problems associated with using urine/blood tests to measure adherence?

Expensive
Limited to clinical practice
Metabolism
Non-adherence masked by adherence just prior to test
Delay in lab reports delays interventions until after point of care

12

What indirect measures can be used to measure adherence?

Pill counts
Mechanical/electronic measures of dose
Pharmacy records
Pt self-report
2nd-hand reports
Attendance rates for lifestyle Tx

13

What pt factors can influence adherence?

Understanding of information, illness and Tx
Recall of Tx and regime
Health belief model

14

What illness/disease factors impact adherence?

Adherence increases when pts experience symptoms
Severity of disease: pts in objectively poorer health with less serious disease more likely to be adherent, pts in objectively poorer health with more serious diseases less likely to adhere

15

What treatment factors can affect adherence?

Preparation - Tx setting, waiting time etc
Immediate character - complexity of regimen, duratio, degree of behaviour change
Administration
Consequences - physical/social S/E

16

What psychosocial factors can affect adherence?

Psychological health
Social support
Social context

17

Has a 'non-compliant' personality been identified?

No, seen in all types of pts

18

What healthcare factors can impact adherence?

Organisational setting
Prescriber beliefs and attitudes towards Tx
Dr-pt interaction

19

What is unintentional non-adherence?

Capacity and resource limitations prevent pt from following Tx regardless of motivation

20

What does intentional non-adherence arise from?

Beliefs, attitudes and expectations that influence pt motivation

21

What is compliance?

Extent to which pt complies with medical advice

22

What does concordance refer to?

Nature of the interaction b/w clinician and pt when negotiating Tx regimes

23

Why is better adherence associated with concordance?

Beliefs and barriers addressed and trust built up

24

What different focuses of address are needed in unintentional non-adherence compared to intentional?

Practical barriers in unintentional
Perceptual factors in intentional

25

What stages are involved in concordance?

Define problem --> convey equipoise --> describe Tx options --> provide info in preferred format --> check pt understanding --> pt concerns and expectations --> ascertain pt preferred role --> defer if necessary --> review

26

Where can tensions arise in concordance?

Between evidence based medicine and pt choice
Pt autonomy and responsibilities