9) Adherance Flashcards
What is compliance?
Extent to which patient complies with medical advice e.g. patient does what they are told
What is adherence?
Extent to which patient behaviour coincides with medical advice e.g. more patient centred, need for agreement
What is the problem of non-adherence?
Seen often in chronic or transplant patients e.g diabetes
Lots of hospital admissions due to non-adherence
What is the impact of non-adherence?
Patient’s health
Financial implications
Why is measuring adherence difficult?
Difficult to define - is it not taking enough, too much, wrong timings?
Treatment not usually a one off so hard to track
Hard to compare studies - lack of consistency
What are some direct measures of adherence and their limitations?
Urine or blood test - invasive, limited to clinical
Observation of consumption
What are some indirect measures of adherence and their limitations?
Pill counts
Record time when container opens - can’t tell if medication taken
Self report - bias
Estimation by doctors or carers - inaccurate
What disease/illness factors affect adherence?
Adherence better when patients are experiencing symptoms
Are patients used to being in poor health, chronic less likely to be adherent
What treatment factors affect adherence?
Side effects
Complexity of regime
Duration
Supervision and support
What patient factors affect adherence?
Understanding illness
Recalling
Beliefs about illness and medication
Priorities, may want to drink
What psychosocial factors affect adherence?
Depressed less likely to adhere
Social isolation and homelessness less likely
What healthcare factors affect adherence?
Follow up = better adherence
Easy access
Trust of prescriber
Dr-patient interaction - friendly
What is unintentional non-adherence?
Capacity or resource limitations that prevent patients from following treatment regime
e.g. memory, poor access
What is intentional non-adherence?
Arises from beliefs, attitudes and expectations that influences patient’s motivation to begin and persist with treatment
What is concordance?
Interaction between clinician and patient, making sure patient makes decisions with doctor
