Adhereance & Consultation Flashcards
What does contraindication mean?
Factor or reason not to give medication / consequence if medication is given
What is an adverse drug reaction?
Unwanted, unexpected or harmful reaction which occurs after medication administration
What is adherence?
- patients’ actions/behvaiours in relation to agreed healthcare proffesionals reccomendations.
- compliance of following treatment reccomendations
Why is adherence important?
-Limits medication benefits
- can cause further deterioration in health
-affects the economic cost to the NHS
- causes more pressures on NHS
Who’s responsibility is adherence?
Everyone involved with the patients care
What are the 3 steps of medical adherence?
- Initiation (first dose)
- Implementation (regime followed)
- Discontinuation (pt stops medication)
What is non adherence?
- hesitant to start therapy
- dose skipping ( forgetful)
- dose self adjustment (money saving)
- overadherence (taking more)
- wrong administration (ignore guidelines)
- discontinuation
What are the 5 adherence phenomenon factors
- therapy
- disease
- patient
- social and economic
- health system
Related factors
Therapy factor of rasons for non adherence
- duration
- number of tablets
- intake frequency
- intake at meals ( parkinsons)
- packaging change
- polypharmacy ( multiple meds)
Patient factors for reasons of non adherence
- age
- religious beliefs
- anxiety of adverse affects
- language barriers
- patient expert
-poor medical literacy - lack of involvement with process
Social economic facts for non adherence
- cost
- poverty issues/post code lottery
- biophychosocial
- cost of treatment
- cultural beliefs
Health system factors for non adherence
- availability of drug
- lack of trust
- poor communication
- multiple prescribers ( parkinsons)
Intentional non adherence
- addiction to pain relief
- much housinings
- perceptions
- fears
Non intentional non adherence
Beliefs
Adverse affects
Dementia
Poor communication
Cost
Complications
Education
What’s medication optimisation
Looks at the value medications have to offer ( cost and clinical efficiency)
Ensuring the patients get the right choice of medication.
How do we improve medication optimisation?
-patient education
- simplifying prescriptions (East to follow)
- regular reviews ( isit needed?)
- electronic reminders ( apps)
- continuity of care ( record keeping)
- individual support
- synchronised prescriptions
ALL NEEDS EMPOWERMENT, SUPPORT AND ENABLING
How do we improve patient adherence
- support groups (charity, supportive practitioners)
- educational strategies
- behavioural strategies (goals, coping, working with pts ADL)
- organisational (shared decision making, empowerment)
What is a consultation?
Two way interaction with patients to discuss medication information.
Offers diagnosis/opinions and offer treatment options
Open ended questions used
How to improve consultations?
- adopt a style to suit individual needs
- avoid medical jargon
- non judgemental
- supportive
- understand patients fears/belief
- pt centred
- allow patient to find own solution
- recall/ check understanding
What is the calgony Cambridge model?
5 stage consultation approach
1. Initiate
2. Gather information
3. Physical exam
4. Explore and plan
5. Close session
This provides structure and builds relations ships
Challenges and barriers to consultations?
- time constratints (15mins)
- patients don’t always have one particular problem ( deal with most important first)
- biopsychosocial ( housing, education, finances, relationships)
- conflicting angendas ( what’s Important)
What is pharmacodynamic
What the drug does to the body
What is pharmacokinetics
What the body does to the drug
(Absorption/metabolism)
