12 - Adherence and Concordance Flashcards
What are the definitions for compliance and adherance?
Compliance - The extent to which a patient complients with medical advice
Adherance - The extent to which a person’s behaviour, e.g taking medication, corresponds with agreed recommendations from healthcare provider. Patient has right to choose
What are some examples of non-adherance?
- Not picking up prescription
- Taking more or less medication than prescribed
- Taking medication at wrong time
- Not changing life style
What is the adherance with common conditions like?
- Low adherance with common conditions and adherance reduces over time
- More severe the disease, higher the adherance
What are the consequences of non-adherance?
- Wider economic burden
- Health benegits forgone
How can we measure adherance?
Directly - Urine or blood test
Indirectly - Pill counts, mechanical measures of dose, patient self-report, second hand report like doctors and carers
What are the issues with measuring adherance?
Direct: Cost, limited to use in clinic, can take medicine but doesn’t mean it is as prescribed and taking every day
Indirect: Hard to compare studies for different conditions, just because no pill can’t prove it has been taken or been lost, issues with recall, bias, overreporting adherance
Why do patients non-adhere?
- Unintentional: patients want to adhere but can’t due to factors out of their control, e.g cost, poor recall, difficulties administering
- Intentional: patient doesn’t want to based on their beliefs, attitudes and experiences
How does recall affect adherance?
The more a patient can remember about their condition and the instructions, the more likely they are to adhere so need to make treatment simple
How do we address unintentional adherance?
- Educate patient on medicine and disease
- Simplify treatment regime
- Physical aids and reminders
What are some beliefs, attitudes and expectations that will cause a patient to intentionally non-adhere?
- Don’t realise severity of disease
- Lack of symptoms so don’t want side effects
- Stigma
- Actively modify regime so it fits with their lifestyle and beliefs
- Prefer a good QoL (i’m gonna die anyway)
How does social support affect adherance?
- More social support, more likely to adhere
- Quality of interaction with and trust in healthcare provider will make them more likely to adhere
What are the five factors affecting adherance?
What is concordance?
The process of negotiation between patients and doctors over treatment regimes, in which patient’s beliefs and priorities are respected and the decisions are made in partnership between patient and doctor.
Helps to overcome intentional non adherance
How can we improve intentional adherance rates?
- Concordance
- Adress patient misconceptions
- Surface barriers to adherance and how to overcome
- Patient/doctor trust
- Discuss what the patient wants to achieve
- Provide clear information about disease and pros and cons of treatment
