Adherence

Question 1

Why does adherence matter?

Answer 1

Treatment efficacy (how well a treatment works)
Cost of wasted medications

Question 2

two ways on which adherence is decreased *

Answer 2

When a lot of effort or sustained effort is required, or is associated with negative emotions
(more than one pill a day, duration you need to take a pill for, side effect profile, does it hurt, brings forward negative emotions, no external motivation)

Chronic diseases for example
e.g. lowest adherence is to surgical/injury rehabilitation

Question 3

What is creative non- adherence

Answer 3

When the patient modifies or supplements a regime, (intelligent no adherence)
e.g
Alterations in dosage to extend treatment (pill splitting)
Retain medications for future use or family
Supplements (possibility of interactions)
Double dosing

Question 4

Generally when asked about adherence patients will?

Answer 4

Over estimate, as they are ‘supposed’ to take pills

Question 5

Physician ways to improve adherence

Answer 5

Physician

• Get patient to red bak to you the instructions
• Keep prescriptions simple, written instructions
• Use pill containers and reminders
• Call when miss appointment
• Try factor in lifestyle
• Acknowledge efforts

Question 6

Institution

Answer 6

Mail based reminders
reduce wait times
Incentives

Question 7

Treatment factors related to adherence

Answer 7

Treatment itself: dosage; duration; number of tablets; number of times per day; complexity; storage; side effects
Practical: Travel time, medication costs
Demographic: extremes of age + minorities

Question 8

Adherence and psychosocial characteristics

Answer 8

Practical and emotional social support, family cohesiveness, marital status
Cognitive: risk/benefit beliefs, knowledge

Question 9

Emotional links to adherence

Answer 9

Lower in
depression, stress, anxiety, HQOL score,

More complex than just patients memory, ignorance of forgetfulness

Question 10

6 cases of variables that might increase adherence (why adherence might be low also)

diabetes example

Answer 10

Demographics: better suited to identifying at risk person
Institutional: Centralised reminder system
Physician: Superior with shared treatment goals
Technological: alarms, electronics
Cognitive: knowledge of CHD risk for example
Socio-emotional: Stress management, try raise this