8. Treatment adherence

Question 1

What is compliance and adherence?

Answer 1

• Compliance - action/fact of applying with a wish or command
• Adherence - attachment or commitment to a person, cause or belief

Question 2

What does compliance refer to (with reference to treatment)?

Answer 2

The extent to which a patient follows a doctor’s prescription about medicine taking

Question 3

What does adherence refer to (with reference to treatment)?

Answer 3

The extent to which a patient’s behaviour (taking medication, following diet etc.) corresponds with agreed recommendations from a health care provider

Question 4

What does concordance refer to (with reference to treatment)?

Answer 4

• Agreement reached after negotiation between a patient and a healthcare professional
• Respects the beliefs and wishes of the patient in determining if/how medicines are to be taken

Question 5

What can increase the risk of poor adherence?

Answer 5

• Longer duration of treatment

* More complex regime

Question 6

What direct methods can be used to measure non-adherence?

Answer 6

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

Question 7

What indirect methods can be used to measure non-adherence?

Answer 7

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

Question 8

What is the overall average rate of adherence to treatment in long-term conditions, in developed countries?

Answer 8

50%

Question 9

What percentage of hospital hospital admissions is caused by a lack of medication adherence, in the US?

Answer 9

10%

Question 10

Why might intentional non-adherence occur?

Answer 10

• Patient beliefs and motivations

* Side effects

Question 11

Why might unintentional non-adherence occur?

Answer 11

• Cognitive difficulty - forgetting to take medication

* Language barrier

Question 12

Describe the current model for non-adherence and its use

Answer 12

• COM-B model
• The performance of a behaviour is caused by the interaction between:
- capability
- opportunity
- motivation
• Intended as a starting point for choosing interventions that are most likely to be effective

Question 13

Why is non-adherence often a ‘hidden problem’?

Answer 13

Undisclosed by patients and unrecognised by prescribers

Question 14

How can adherence be improved?

Answer 14

• Improve patient’s understanding of illness and treatment (influence patient beliefs)
- provide clear rationale
- elicit concerns
• Help patients to plan and organise their treatment
- identify any possible barriers

Question 15

In a study where (non-adhering) patients with long-term asthma received tailored-texts over time, how did their beliefs change?

Answer 15

• Perceived necessity of preventer medication increased
• Increased belief in the long-term nature of their asthma
• Increased perceived control over their asthma