4b: Treatment adherence

Question 1

Define adherence

Answer 1

the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider

Question 2

Importnat distinction between compliance and adherence

Answer 2

Compliance: the action or fact of applying with a wish or command.

Adherence: attachment or commitment to a person, cause, or belief.

Question 3

Who is best at measuirng concordance

Answer 3

limited concordance in health professionals’ judgement of patient adherence

patients best

Question 4

Direct methods of non-adherence

Answer 4

DIRECT:

• Directly observed therapy
• Measurement of medicine in blood
• Measure of biological marker in blood

INDIRECT: 
Patient questionnaire
Patient self-report
Pill counts
Rates of prescription refills
Electronic medication monitors
Patient diaries

Question 5

Consequence of non-adherence

Answer 5

Poor health outcomes

Increased healthcare costs

Question 6

Model of non-adherence

Answer 6

UNINTENTIONAL NON-ADHERENCE

• Patient ability and resources
• Practical patient barriers to adherence

INTENTIONAL NON-ADHERENCE

• Patient beliefs and motivations
• Patient perceptual barriers to adherence

Question 7

Example of overlap between intentional and unintentonal adherence

Answer 7

there is considerable overlap between the two, e.g. health beliefs will influence “unintentional” non-adherence such as forgetting

Question 8

Model for cause of non-adherence

Answer 8

COM-B

interaction between:
Capability
Opportunity
Motivation

Question 9

CAPABILITY as a cause of non-adherence

Answer 9

PHYSICAL:

• capacity to adapt to lifestyle changes
• dexterity

PYSHCOLOGICAL:

• Comprehension of disease and treatment
• Cognitive function (memory, capacity for judgement, thinkging)
• Executive function (capacity to plaN)

Question 10

Outline motivation as a cause of non-adherence

Answer 10

REFLECTIVE:

• Perception of illness (cause, chronic etc)
• Belief about treatment (necessity, concerns about adverse effects, general aversion to medicine)
• outcome expectance
• self efficacy

AUTOMATIC
-mood state/disorder (anxiety)

Question 11

Outline opportunity as cause of non-adherence

Answer 11

PHYSICAL

• Cost
• Access
• Packaging
• Physical characteristics (taste, smell size, ROA)
• Complexity of regimen
• Social support

SOCIAL

• stigma of disease and fear of disclosure
• religious/cultural beliefs

Question 12

What is an important factor in adherence

Answer 12

Illness perception (causal beliefs)

Question 13

What else is important apart from illness beliefs in nonadherence

Answer 13

BELIEFS ABOUT THE TREATMENT

Question 14

What influences specific beliefs about treatment

Answer 14

Doubts about NECESSITY

(how necessary for maintaining health)

and

CONCERNS about potential adverse effects

–>LOW adherence

Question 15

What can patient beliefs about illness and treatment be influenced by

Answer 15

by symptoms

May be based on mistaken beliefs

Question 16

How can adherence to treatment be improved

Answer 16

1. Improve understanding of illness and treatment
2. Help patients plan and organise treatment

INFORMED ADHERENCE in consultation
-Check patient undertanding of treatment (provide clear rationale, elicit concerns, practical plan for when to take, identify barriers)

Question 17

Examples of interventions

Answer 17

Text message

introducing a plan linked to environmental cues

eliciting and modifying any mistaken patient beliefs regarding medication/stroke