Week 8 - Adherence Flashcards
1
Q
What is compliance and what are some problems with it?
A
The extent to which the patient complies with medical advice
- Problems: patient does what they are told, doctor knows best, powerful doctor/passive patient
2
Q
What is adherence?
A
The extent to which patient behaviour coincides with medical advice
- Attempt to be more patient-centred
- Need for agreement
- Patient’s right to choose
3
Q
What is concordance?
A
- Negotiation between patient and doctor over treatment regimes
- Patients beliefs and priorities are respected
- Patient is active and can make decisions in partnership with the doctor
- Refers to the nature of the interaction between clinician and patient
4
Q
Why is concordance better than adherence?
A
- Patient is involved in, and has shared ownership of, decisions about treatment
- Patients’ beliefs, expectations, lifestyle and priorities can be taken into account
- Barriers to adherence can be addressed
- Promotes patient trust and satisfaction with care
5
Q
What are some non-adherence problems?
A
- Non-adherence to medical advice is the norm
- Chronic illness:
- – 50% are non-adherent
- – 10-25% of all hospital admissions are due to non-adherence
- Non-adherence to type of treatment regimen:
- – Medication: 20.6%
- – Exercise: 28%
- – Health behaviour: 31.3%
- – Diet: 41.7%
- Common even in more severe diseases and transplant patients
- – 22% of adult renal transplant patients are non-adherent to immunosuppressant medications
- – 91% of non-adherent patients experience organ rejection or death
- Highest rates of adherence
- – HIV, arthritis, GI disorders, cancer
- Highest rates of non-adherence:
- – Pulmonary disease, diabetes, sleep disorders
- Has an impact on patient’s health
- Financial implications
6
Q
What are some problems with measuring adherence?
A
- What ‘counts’ as adherence
- – Not taking enough
- – Taking too much
- – Not taking at prescribed intervals
- – Taking some, but not all medication
- – Taking medication that is not prescribed
- Treatment not usually a ‘one-off’event
- – Usually continues over a period of time
- – When do we assess adherence?
- Lack of consistency in measures
- Hard to compare studies for different conditions with different medication or treatments
7
Q
How can you directly measure adherence?
A
- Urine/blood test
— Advantages: provides most direct measure of consumption/adherence
— Disadvantages:
• Expensive
• Limited to use in clinical practice
• Invasive
• May be affected by metabolism
• Non-adherence may still be masked
• E.g. may only take medication properly just prior to tests
• Results aren’t available at time of test, so can’t discuss results with patient straight away - Observation
— E.g. watch them consume medication
— Similar problems to blood/urine tests
8
Q
How can you indirectly measure adherence?
A
- Pill counts
— Subject to inaccuracy
• E.g. lost pills - Mechanical or electronic measures of dose
— E.g. record time at which container is opened
— Advantages: objectively measures whether a dose has been dispensed, more accurate than other indirect measures
— Disadvantages: doesn’t measure whether medication has actually been taken - Pharmacy
— See whether medication has been collected - Patient self-report
— Advantages: easy to obtain, inexpensive
— Disadvantages: prone to inaccuracies, bias, over-reporting adherence - Second-hand report:
— From doctors, carers, etc.
— Similar advantages and disadvantages to patient reports
— Depends on familiarity with patient
9
Q
What is unintentional adherence?
A
- Arises from capacity and resource limitations that prevent patients from following treatment recommendations
- May be associated with individual constraints and/or associated with aspects of their environment
- – E.g. memory (individual)
- – E.g. problems with accessing prescriptions (environment)
10
Q
What are some reasons for intentional adherence?
A
Arises from the beliefs, attitudes and expectations that influence patients’ motivation to begin and persist with the treatment regime
11
Q
How can you address problems with adherence?
A
- Addressing practical barriers
- Addressing perceptual factors influencing motivation
12
Q
What are some problems with interventions to improve adherence?
A
- Many lack theoretical input
- – Difficult to tell why some interventions work and others do not
- Few are truly ‘patient-centred’
- – Lack of individualising approach to match patients’ needs preferences
13
Q
What are some factors that influence adherence?
A
- Illness
- Treatment
- Patient
- Psychosocial
- Healthcare
14
Q
How can illness influence adherence?
A
- Symptoms
- – Adherence is usually better when patients experience symptoms
- Severity
- – Patients in poorer health are more likely to be adherent to less serious diseases than patients in better health
- – With more serious diseases, patients in poorer health are significantly less likely to be adherent
15
Q
How can treatment influence adherence?
A
- Preparation
- – Treatment setting
- – Waiting time
- – Timing of referral
- – Convenience
- – Poor reputation
- Immediate character
- – Complexity of regimen
- – Duration of regimen
- – Degree of behaviour change
- – Convenience
- – Expense
- – Inadequate labels
- – Container design
- Administration
- – Supervision by healthcare professionals
- – Continuity of care
- Consequences
- – Physical side effects
- – Social side effects
- – Stigma
