6) Adherence & Homelessness

Question 1

What is adherence?

Answer 1

The extent to which a person’s behaviour (following a diet/executing lifestyle changes) corresponds with agreed recommendations from a healthcare provider.

Question 2

What did adherence used to be known as? Why has this changed?

Answer 2

Compliance
Seen as an out a date approach- powerful doctor and passive patient

Now much more important to be patient-centred, need for agreement, patient’s right to choose

Question 3

What are examples of non-adherence?

Answer 3

• failing to pick up prescription/repeat
• stopping medication before course is complete
• taking wrong dosage
• taking dose at wrong time/missing doses
• taking some but not all medications (multiple types)
• failure to adhere to lifestyle changes

Question 4

Highlight consequences of non-adherence

Answer 4

For patients: health benefits forgone (poor health-related quality of life, increased hospitalisations and premature mortality)
Wider society: wider economic burden (person, health- higher demand on healthcare- and social cost)

Question 5

What are the 2 types of non-adherence?

Answer 5

Unintentional: practical problems that prevent them from sticking to their treatment regime

Intentional: they choose not to adhere because they don’t want to follow the regime

Question 6

Describe un-intentional NA

Answer 6

• patients want to follow their treatment but are prevented from doing so by barriers outside of their control
• examples include: poor recall or comprehension of instructions, difficulties in administering treatment, inability to pay for the treatment, forgetting to take it

In the elderly there may be a problem with dexterity (cannot open medication cases) overcome with all tablets for the day in a box- hence wont miss out any medications, easier to open

Question 7

Describe intentional NA

Answer 7

• the person decides not to follow the treatment regime

- based on their beliefs (of illness/treatment), attitudes and expectations

Question 8

Outline some common interventions to improve adherence. Which type of A would this improve?

Answer 8

To improve un-intentional NA:

• educating the patient on medicine and condition to increase knowledge (understand importance of treatment)
• simplifying the regime
• making it easier to remember to use the medicine (physical aids and reminders ie an alarm on the phone at the same time everyday)

Question 9

How do patient beliefs about illness affect adherence?

Answer 9

Beliefs about illness:

• severity
• lack of symptoms (doesn’t feel condition is affecting their life)
• understanding of illness ie chronic vs episodic

Relates to health belief model
- threat of illness/ methods to address complaints

Question 10

How do patient beliefs about medications affect adherence?

Answer 10

• may be predisposed not to take medication (stoical attitude)
• necessity/ harmful or unpleasant side effects, addiction. (Especially if asymptomatic)
• stigma
• concerns about conflict with activities ie drinking alcohol (affecting quality of life as perceived by the patient)

Question 11

Outline other factors that impact on adherence

Answer 11

• social support (especially practical support)
• quality of interaction with and trust in the healthcare provider (communication, interpersonal competence, perceived skill)

Question 12

Outline the factors within the ‘Multi-dimensional model of adherence’

Answer 12

• patients factors
• illness factors
• treatment factors
• psychosocial factors
• healthcare factors

Question 13

Illustrate the multidimensional model

Answer 13

Model:
Patient factors=Beliefs &understanding, satisfaction, memory.

Psychosocial factors=Social support, psychological health

Healthcare factors=Setting, Dr-Pt interaction, communication, concordance

Treatment factors=Preparation, side-effects, complexity, experience, efficacy, stigma,…

Illness factors= Symptoms, severity