Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

hp: 3.2 adherence to medical advice > 3.2.1 Types of non-adherence and reasons why patients do not adhere > Flashcards

3.2.1 Types of non-adherence and reasons why patients do not adhere Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

What is medical adherence?

Medical adherence

A

The extent to which patients take medications as prescribed by healthcare providers.

According to WHO - “The degree to which the person’s behaviour corresponds with the agreed recommendations from a healthcare provider”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is medical adherence?

Two main types of non-adherence

A
  • Failure to follow treatments
  • Failure to attend appointments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Failure to follow treatment

3 types of failure to follow treatment

A
  1. Primary non-adherence
  2. Non-persistence
  3. Non-conforming
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Failure to follow treatment

Primary non-adherence

A

This is when the patient fails to even present the prescription to the pharmacy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Failure to follow treatment

Non-persistence

A

This is when the patient starts to take the medication but stops without being advised to.

This might happen because they begin to feel better, or forget to take it, or can’t afford to get more: it’s not usually intentional.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Failure to follow treatment

Non-conforming

A

This is when the patient does not take the medication as prescribed, so they might miss a dose or take it at the wrong times.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Non-adherence

Problems associated with both types of non-adherence

A
  1. Waste of medication: huge economic consequences as well as the fact the patient might not get well.
  2. Time lost: health care workers could be looking after people who need care.
  3. Progression of illness: the person may get worse.
  4. Increased use of medical resources: need hospitalisation (more expensive).
  5. Reduced functional abilities: the person may get worse and not be able to work or care for others.
  6. Lower quality of life: due to decline in patient.
  7. Impact on medical research: if courses of treatment are not followed researchers cannot move forwards.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Evidence of low adherence rates

Simons et al. (1996)

A

Even for Statins (drugs to reduce cholestrol which have few side effects), adherence rate is only 70%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Evidence of low adherence rates

Taylor (1990)

A

Suggested that 93% of patients fail to adhere to some aspect of their treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Evidence of low adherence rates

Becker (1972)

A

Looked at whether a prescribed anti-biotic was being taken halfway through a 10-day treatment programme in young children.

Over half the mothers had stopped giving the medicine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Evidence of low adherence rates

Sarafino (1994)

A

People adhere less for chronic illness than for short-term treatments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Medical adherence vs patient compliance

Compliance

A

Suggests that the patients is passively following the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between the patient and the physician.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Types of non-adherence

Two forms of medication non-adherence

A
  • Intentional medication non-adherence
  • Unintentional medication non-adherence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of non-adherence

Intentional medication non-adherence

A

Active process whereby the patient chooses to deviate from the treatment regimen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of non-adherence

Unintentional medication non-adherence

A

Passive process in which the patient may be careless of forgetful about adhering to treatment regimen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Types of non-adherence

Negative effects of medication non-adherence

A
  • Increased hospital readmission
  • Increased disease progression and complications
  • Increased health care costs
  • Decreased quality of life
  • Patient death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bulpitt (1994)

Rational non-adherence

A

The idea we make rational choices based on the info that is available to us at the time.

We weigh the cost-benefits and if costs are higher than percieved benefits, we may not adhere.

This is rational.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bulpitt (1994)

Background info

A

Looked at elderly patients with hypertension (high blood pressure).

Previous research had shown many health risks to drug treatment in the elderly, such as gout, chest pain and change in bowel habits.

Benefits of medication were that coronary events were reduced by 44% with a mixture of drugs prescribed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Bulpitt (1994)

Aims

A

To review research on adherence in hypertensive male patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Bulpitt (1994)

Hypertension

A

High blood pressure - no real short-term effects, but in the long-term can lead to heart disease and strokes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bulpitt (1994)

Procedure

A

Reviewed articles of a range of research which identified problems with taking medication for high blood pressure.

He analysed the research to identify the physical and psychological effects of drug treatment on a person’s life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Bulpitt (1994)

Findings

A

Anti-hypertensive drugs have many side effects including sleepiness, dizziness and lack of sexual functioning.

They also affect cognitive functioning and so work hobbies may be curtailed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bulpitt (1994)

Conclusion

A

When the costs of taking medication (side effects) outweigh the benefits of treating a mainly asymptomatic problem, such as raised BP, the patients is less likely to adhere to treatment.

Asymptomatic diseases may be more difficult to treat than those with symptoms.

He acknowledges the difficulty in measuring the cost-benefit analysis in individuals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bulpitt (1994)

Strengths

A
  • Useful = looks at patterns and sees if attitudes towards medication/adherence change over time.
  • High reliability/generalisability = various pieces of research anaylsed allows cross-referencing.
  • Holistic approach = both physiological and psychological side effects were investigated.
25
Q

Bulpitt (1994)

Criticisms

A
  • Lacks temporal validity = reviewing a dated article of research.
  • Lacks detail = don’t know the depth/validity of the research being looked at, but the review article appears to be fairly brief.
26
Q

Laba et al. (2012)

Aim

A

To investigate what factors contribute the most to rational non-adherence and whether factors relating to specific medicines and patient background contribute to non-adherence.

27
Q

Laba et al. (2012)

Participants

A
  • 248 Australians
  • Median age: 57 years old
  • 45% female, 55% female
  • 161 Australians took part in the survey
28
Q

Laba et al. (2012)

Method

A

Experiment

29
Q

Laba et al. (2012)

What were participants asked to complete?

A

An online survey.

30
Q

Laba et al. (2012)

How was the online survey organised?

A

There were 3 sections:
1. Questions about current medication use.
2. Discreet Choice Experiment (DCE).
3. Background info about the participant.

31
Q

Laba et al. (2012)

Discreet Choice Experiment (DCE)

A

Where 10 hypothetical situations were presented and participants were asked to choose from 1 of 2 alternatives.

Ppts were asked to imagine they were currently taking 2 medications for different long term conditions and were asked which they would be happiest continuing taking.

32
Q

Laba et al. (2012)

Examples of factors given to participants about each medication

A
  • Symptom severity
  • Symptom frequency whilst on medication
  • Severity of medication side effects
  • Chance of early death from the illness whilst on medication
  • How the medication is taken
  • Alcohol restrictions
  • The monthly cost to the patient of the medication
33
Q

Laba et al. (2012)

Why did researchers get participants to rate how much each factor would impact them taking the medication?

A

They wanted to see which of the factors was the most important.

34
Q

Laba et al. (2012)

How many versions of the survey were there?

A

4 versions, plus a repeated choice set to check for consistency and rationality behind the decision choices.

35
Q

Laba et al. (2012) - results

How many factors had a significant effect on decisions to continue taking the medication?

A

6 out of the 8 factors had a significant effect.

36
Q

Laba et al. (2012) - results

Which 2 factors did not have a significant effect on adherence?

A

Symptom severity and alcohol restrictions.

37
Q

Laba et al. (2012) - results

Who was monthly cost a significant factor for?

A

Participants without private medical insurance.

38
Q

Laba et al. (2012) - results

What were participants willing to do between different factors?

A

Trade.

For example, more willing to take treatment if they were only taking once a day rather than four times a day, however, they would take it four times a day if it reduced risks of unwanted side effects in the future by 20%.

39
Q

Laba et al. (2012) - results

Harms were considered to be more important than benefits by how many participants?

A

58%.

40
Q

Laba et al. (2012)

Conclusions

A

Patients make rational choices.

Adherence could be improved by:
* reducing costs of medication
* altering regime
* educating patients on medication benefits.

41
Q

Laba et al. (2012)

Strengths

A
  • Usefulness = showed factors that influence patients’ adherence to their treatment regime. Could help practitioners design interventions to improve adherence in the future.
  • Quantitative data = objective, quantitative data from discrete-choice questionnaire gave high reliability to results.
42
Q

Laba et al. (2012)

Criticisms

A
  • Representativeness = only 248 people took part, with only 161 completing the survery - 10% participation rate.
  • Low ecological validity = questionnaire scenariois were all hypothetical and may not reflect real life.
43
Q

Extent of non-adherence problems

Difficulties with assessing adherence/non-adherence

A
  • Many kinds of medical advice to which one could adhere.
  • Can violate advice in many ways.
  • Difficult to know if patient complied (50/50 chance that the physician’s judgement of the patient’s adherence is accurate).
44
Q

Issues and debates

How does Laba’s study and the HBM show individual/situational explanations?

A

Laba’s study is seeking to find individual and situational factors that affect whether people adhere to medication.

The HBM depends on individual reasoning.

44
Q

Issues and debates

How do Laba and Bulpitt’s studies have RWA?

A

All these studies aim to help us understand why people may not adhere.

If we know this we can put measures into place to avoid non-adherence and all the negatives that come from this.

45
Q

Issues and debates

How does Laba’s study show reductionism vs holism?

A

Admits there are many reasons why people do not adhere, Laba took age/gender/income into account.

Recognised these factors + choices made by people (trade-offs) interact and so are more holistic than reductionist.

46
Q

Issues and debates

How does Laba’s study and the HBM show idiographic vs nomothetic?

A

Laba uses quantitative method and HBM uses qualitative, overall they are more nomothetic and look to explain non-adherence to a wide range of people.

47
Q

Issues and debates

How well does Laba’s study generalise?

A

Generalisations of findings are possible since the sample was representative.

48
Q

The Health Belief Model

What does the Health belief model aim to predict?

A

When a person will engage in preventative health measures, such as changing their diet, stopping smoking, taking more exercise, attending screenings etc.

49
Q

The Health Belief Model

The HBM suggests that whether a person will engage in preventative health measures depends on what 2 assessments that they will make?

A
  1. Evaluation of the threat.
  2. A cost-benefit analysis.
50
Q

The Health Belief Model

Perceived severity

A

Somebody would be less likely to adhere to medication for a minor illness than for a more serious one.

51
Q

The Health Belief Model

Perceived susceptibility

A

Somebody would be less likely to adhere to medication if they don’t think they are at risk of illness.

52
Q

The Health Belief Model

Perceived benefits

A

Someone is less likely to adhere to medication if they don’t feel confident the treatment will work.

53
Q

The Health Belief Model

Perceived barriers

A

People are less likely to adhere if they percieve barriers to be in place, such as inconvenience, cost, discomfort.

54
Q

The Health Belief Model

Cues to action

A

A person is more likely to adhere to medication if they have been exposed to a trigger, such as a loved one dying from a similar condition.

55
Q

The Health Belief Model

Self-efficacy

A

Someone is more likely to adhere to medication if they have confidence that they can see it through and keep up with the treatment plan.

56
Q

HBM - Cost-benefit analysis

What is the cost-benefit analysis?

A

When someone weighs up the benefits they will get from adhering to medical advice, compared to the social/physical/time/monetary costs.

57
Q

The Health Belief Model

Strengths

A
  • Has supporting empirical evidence.
58
Q

The Health Belief Model

Criticisms

A
  • Self-report measures = so may be subject to social desirability bias.

hp: 3.2 adherence to medical advice (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions