Adherence

Question 1

Types of non-adherence and reasons why patients don’t adhere

Answer 1

P1 - types of non-adherence and problems caused by non-adherence
P2 - why patients don’t adhere: rational non-adherence (Bulpitt)
P3 - the health belief model (Becker)

Question 2

Measuring non-adherence

Answer 2

P1 - subjective: self-reports (Riekart and Droter)
P2 - objective: pill counting (Chung and Naya)
P3 - biochemical tests (Roths )
P4 - repeat prescriptions (Sherman)

Question 3

Improving adherence

Answer 3

P1 - improve practitioner style (Ley)
P2 - behavioural techniques
- (Yokley and Glenwick)
- (Watt et al)

Question 4

What are the two types of non-adherence?

Answer 4

• intentional & non-intentional
• makes a conscious decision not to seek treatment
  e. g. not taking drugs
• does not make
  e. g. forgot to attend

—> extra doctor visits, serious illness/death

Question 5

Describe Bulpitt

Answer 5

• based on CBA
• literature review
• risks + benefits of hypertension drugs in elderly
• positive effect 44% reduction in coronary events
• less effective for those who smoke
• negative effect: gout

—> overall benefit outweighed the risks, risks more obvious, benefit long term preventative nature

Question 6

Describe Becker’s health belief model

Answer 6

• rational decision of individual + situational factors
• evaluation of threat of illness
• individual susceptibility + severity, previous experience, advice from others
• based on CBA, benefit-cost (side effect)

—> COMBINATION of CBA + perception of threat can influence the likelihood of adherence

Question 7

Describe Riekart & Droter

Answer 7

• questonnaire/interview ask a patient or doctor if the patient is following the doctor’s advice
• teenage diabetic patients who did not return questionnaire=lower adherence levels based on medical records

—> adherence data collected from self report biased towards higher levels of adherence cuz those more likely to return

Question 8

Describe Chung & Naya

Answer 8

• no. of doses actually taken VS should have been taken
• TrackCap, track each time bottle is opened+times it is opened
• asthma medication 18-55yrs
• adherence (taking pills at correct times) 71%, compliance (times bottle opened) 89%

Question 9

Describe Sherman

Answer 9

• no. of times picked up prescription VS no. of prescriptions issued
• studied accuracy of pharmacy records, and adherence levels to medication for asthmatic children based on repeated prescription info
• pharmacy records 92% accurate, and showed low levels of adherence (38%-72%)
• BUT doctors only identified 1/2 of low adherers

—> pharmacy records provide more accurate + valid measure, than self-report measures from doctors

Question 10

Describe Roth

Answer 10

• literature review
• of self-report, pill counting, biochemical testing
• patients+doctors overestimate adherence
• self-report lacks validity
• pill counting only measures removal rather than intake

—> biochemical tests, measures concentration of medication in blood/urine, more valid of whether actually taken

Question 11

Describe Watt et al

Answer 11

• replace asthma spacer with funhaler spacer
• field exp, repeated measure
• 32 Australian children mean age 3.2
• standard inhaler 1st week + funhaler 2nd week
• 38% more parents medicated their children, 60% more children took the recommended 4 or more cycles per delivery
• funhaler improve both parental + child adherence, making medication fun

Question 12

Describe Yokely & Glenwick

Answer 12

• to evaluate the relative impact of prompts for motivating parents to take their children to be immunised
• midwest city
• message based on info from medical records
• 12 weeks, % attend immunisation clinics
• general, specific, specific+increased access, specific+monetary incentive
• monetary most effective, increased access also effective and cheaper to do