3) Health behaviour and adherence

Question 1

What is compliance? Why is this term not frequently used anymore?

Answer 1

Theextenttowhichthepatientcomplieswithmedical
advice. This term isn’t used frequently as it suggests the doctor is in an all powerful position and the patient’s thoughts and ideas are ignored.

Question 2

What is adherence? Why is this a better term than compliance?

Answer 2

Theextenttowhichpatientbehaviourcoincideswith

medicaladvice. This term is preferred as it is more patient-centred i.e.needforagreement,patient’srighttochoose

Question 3

What are some of the issues with trying to measure adherence?

Answer 3

• Hard to know what‘counts’asadherent (does everything have to be taken exactly? Too much? Not enough?)
• Treatment not normally a one-off, normally taken over a long period of time
• Lack of consistency in measures

Question 4

Why is non-adherence an issue for medicine/the NHS?

Answer 4

• Impact on patient’s health

- Financial implications - increase likely to be larger if you tackle adherence, rather than better medicines

Question 5

How might you measure adherence directly?

Answer 5

• Blood test
• Urinanalysis
• Directly observed therapy (DOT)

Question 6

How might you measure adherence indirectly?

Answer 6

• Pill counts
• Mechanical/electronic measures of dose
• Patient self-reports
• Secondary reports (clinicians, carers)

Question 7

Suggest reasons why patients don’t adhere to medical treatments?

Answer 7

• Asymptomatic so don’t see need (BP meds)
• Medication issues such as time consuming, difficult
• Side-effects
• Patient understanding (do they know why they need to take it? Do they know how much they are meant to be taking?)
• Against their beliefs (lay beliefs)
• Disease severity/their susceptibility to disease
• Lay beliefs about medication
• Social isolation
• Relationship with professional

Question 8

What is intentional non-adherence?

Answer 8

The patient purposely doesn’t take the medication as they should as it conflicts with their beliefs, attitudes and expectations.

Question 9

What is unintentional non-adherence?

Answer 9

Capacity/resource limitation results in the inability to adhere - may be down to disability or reduced cognitive ability

Question 10

What is concordance?

Answer 10

The description of a doctor-patient relationship that works together in order to reach agreement and a satisfactory outcome for the both of them.