Adherence

Question 1

What makes up patient behaviour

Answer 1

Compliance + adherence

Question 2

Concordance

Answer 2

Focuses on consultation process
‘Ethos of a shared approach to decision making’
Describes outcome of the shared decision making process
Values patient’s views
2-way communication between patients + healthcare professionals improves satisfaction with their care, better knowledge of their condition + reduced medicine- related issues
- patients can be concordant + non-adherent

Question 3

Adherence

Answer 3

Extent to which patients behaviour coincides with clinical prescription
Medicine-taking is a partnership between HCP + patient = agreed recommendation
Patient is free to decide when to stop or continue taking
We cannot blame patients when they do not adhere/agree to recommendation

Question 4

2 types of Non-adherence

Answer 4

Intentional + unintentional

Question 5

Intentional adherence

Answer 5

Deliberate + associated with patient motivation

e.g. patient heard through friends the medicine can cause specific side effects (perceptual barrier)

Question 6

Unintentional adherence

Answer 6

Patient agrees with treatment but is prevented by barriers beyond control (lack of capacity + resources)
e.g. parkinson patients can’t physically open medicines (practical barrier)

Question 7

Factors affecting non-adherence

Answer 7

• demographic
• age (children rely on parents + become less adherent as they become older)
• low income (relate to non-adherence)
• ethnicity (non-english speaking groups seem to be less adherent)
• education (health literacy - low levels of education linked to non-adherence)
• medication (instruction not always understood)
• depression
• social support
• patient-prescriber relationships (poor relationship = poor adherence, patient not discussing beliefs/concerns)
• others (forgetfulness, disease/drug characteristics, practical (can’t get to pharmacy), beliefs)

Question 8

Compliance

Answer 8

Patient must comply with directions stated on medicine
Non-compliance is deviant/atypical behaviour
Measured by extent patients behaviour matches healthcare professional advice
Doesn’t take into account patient’s beliefs + feelings towards meds
Paternalistic (authoritive approach)

Question 9

Non-adherence

Answer 9

Prevents patients accessing the best treatment…increasing effectiveness of adherence

Question 10

Implications of non-adherence

Answer 10

Affects both patient + healthcare system
Leads to
- increased further treatment
- emergency hospitalisation
- reduce productivity 
- waste of resources

Question 11

How to measure adherence

Answer 11

Indirect measures
- MARS = medication + adherence report scale
- electronic monitoring ‘gold stars’ = expensive + modify behaviour
Direct measures
- patient self reporting (can exaggerate adherence)
- pill counting
- toxicology e.g. urine levels
- clinical markers e.g. blood pressure

Question 12

Improving adherence

Answer 12

patients and practicalities approach (PAPA)
INCREASING PROGRAMME EFFICACY + VALUE
level 3 = tailored PAPA
- support tailored to address individual perceptions
level 2 = perceptions
- take account of key beliefs influencing motivation
level 1 = practicalities
- simplify regimen 
- packaging
- monitoring
- text reminders
- ability