adherence

Question 1

what is adherence?

Answer 1

the extent to which a person’s behaviour corresponds with agreed recommendations eg taking medication, following a diet and or executing lifestyle changes

Question 2

what is the problem with the adherence definition?

Answer 2

too much burden / focus on the patient .. and not as much on the HCP

Question 3

what are subjective methods of measuring adherence?

Answer 3

-patient diary cards
-patient self report - they report their adherence behaviour through interviews questionnaires etc
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Question 4

what are objective methods of measuring adherence?

Answer 4

-direct observation- when the HCP directly observes the patient carrying out treatment etc
- electronic monitors - for medications - tracking when they are being taken etc

Question 5

outline the prevalence of non-adherence in acute illness or diet/ exercise regimens?

Answer 5

acute illness - 20%
diet or exercise regimes - 65%

Question 6

what are examples of implications of non-adherence?

Answer 6

-health consequences - eg poor health outcomes, decreased quality of life etc
-cost - 10-25% of hospital admissions are due to non-adherence

Question 7

what are examples of potential causes of non adherence?

Answer 7

-social factors
-inter and intra personal reasons

Question 8

what are examples of condition related factors that can contribute to non adherence in patients?

Answer 8

-chronic conditions have lower adherence than acute cond
-greater severity of symptoms and disease
-greater level of disability
-faster rate of illness progression

Question 9

describe the relationship between depression and non adherence

Answer 9

• significant and substantial - patients with depression were 3 times more likely to be non-adherent

Question 10

what are examples of therapy related factors that can contribute to non adherence?

Answer 10

-longer duration of treatment
-frequent changes in treatment
-complex treatment regimens eg more exercises etc
-how quickly the patient feels the benefits ie long term vs immediate

Question 11

what are examples of health system / healthcare team factor that contribute to non adherence?

Answer 11

-poorly developed services
-poor medication distribution systems
-lack of knowledge
-short consultations

Question 12

what are examples of socio-economic factors that can contribute to non adherence?

Answer 12

-unemployment
-lack of effective social networks
-unstable living conditions
-distance from treatment centre

Question 13

briefly describe the 2 types of non- adherence

Answer 13

1. unintentional non adherence ie forgetting to adhere eg getting distracted or inability to adhere
   2, deliberate / intentional non adherence - ie choosing not to adhere, patients beliefs and thoughts are important

Question 14

what are some examples of health beliefs that may lead to non adherence in patients?

Answer 14

-not wanting to get addicted to medication
-not believing treatments are worth it
-being too worried about side effects

Question 15

what are 3 strategies that can be used for facilitating adherence in a consultation?

Answer 15

1.understanding of the condition and its treatment - eg encourage questions, ask patients about their understanding
2. memory for information given - emphasise most important aspects, avoid jargon
3. satisfaction with the process of treatment - good communication, open ended q’s

Question 16

how could you address intentional non adherence in a consultation?

Answer 16

-check adherence - normalise poor adherence - eg lots of people forget to do their exercises, have you?
-good relationships - open, communicative and non judgemental relationships with patients
-patient centred care
-clarify misconceptions - ensure good understanding for treatment

Question 17

how would you address unintentional non adherence in a consultation?

Answer 17

• tailor treatment plans and information to patient preferences, needs etc
  -provide written back up information
  -simplify treatment where possible
  -check understanding of how to execute treatment recommendations