7b) Adherence to treatment

Question 1

7b – Adherence to treatment
Key concepts

• Definition, prevalence and consequences of non-adherence to treatment regimes
• Main causes of non-adherence
• Ways of improving adherence to treatment

Answer 1

-

Question 2

Define compliance

Answer 2

Compliance

- extent to which patients follow doctors’ prescription about medicine taking and other treatment behaviours

Question 3

Define adherence

Answer 3

Adherence
- extent to which patients follow through decisions about medicine taking and other treatment behaviours

• 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 4

What are some direct methods of measuring non adherence?

Answer 4

Direct methods include:

• Directly observed therapy
• Measurement of level of medicine / metabolite in the blood
• Measurement of biologic marker in the blood

Question 5

What are some indirect methods of measuring non adherence?

Answer 5

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

Question 6

What is the Impact and consequences of non-adherence

Answer 6

• Poor health outcomes

- Increased healthcare costs

Question 7

describe the COM-B model of behavior in relation to non adherence

Answer 7

interaction btw capability , opportunity + motivation = determines performance of behavior
–> same thing applies to adherence

involves

• -> 9 interventions
• -> 7 policy categories

capability:
- psychological –> capacity to engage in necessary thought process
- physical –> capacity to engage in necessary physical processes

motivation:
- reflective –> evaluation + plans
automatic –> emotions and impulses

opportunity
- physical –> physical opportunity provided by the environment
social –> cultural milieu that dictates the way we think about things

Question 8

Illness perceptions

• reflective motivation factor
• -> but patient’s beliefs about the TREATMENT should also be considered

Answer 8

-

Question 9

note:

Doubts about necessity
+
Concerns about potential adverse effects

= Low adherence

Answer 9

-

Question 10

What are some ways to improve adherence?

Answer 10

• Improve understanding of illness and treatment
• -> check patient’s understanding go the treatment
• Help patients to plan and organise their treatment

others:
- identify possible barrier

Question 11

give an example of an intervention to improve adherence

Answer 11

1) text message programme
- 212 patients w asthma
- received tailored text messages for 18 weeks
- intervention group has increased adherence to treatment

2) Improving adherence to stroke survivors
method:
- -> elicit + modify mistaken patient beliefs
- -> introduce plan linked to environmental cutes to establish better medication adherence
- intervention group has increased adherence to treatment

Question 12

Define concordance

Answer 12

extent to which patients are successfully supported both in decision making partnerships about medicines in their medicine taking .

Question 13

What are the 2 types of non adherence

Answer 13

a) unintentional non adherence
- -> poor health care
- -> cognitive difficulty (memory)
- -> financial barriers

b) intentional non adherence
- -> patient has worries
- -> patent is reluctant to proceed with treatment

Question 14

patient beliefs about illness + treatment –>

• influence adherence
• can be changed
• may not be disclosed in consultation

Answer 14

-