Adherence

Question 1

Learning outcomes

Answer 1

• Describe the key factors that influence adherence to treatment
• Distinguish between intentional and non-intentional non-adherence
• Discuss the importance of practitioner-patient communication for adherence
• Describe simple strategies for improving adherence

Question 2

Adherence

Answer 2

•Attending appointments
•Initiating a recommended treatment
•Completing behavioural recommendations
•Taking medication as prescribed (not missing doses / finishing a course / timings)
•Continuing with treatment as recommended (not terminating treatment prematurely)
•Simple (a pill once a day) –Complex (insulin regimes)
Non-adherence can be intentional or non-intentional

WHO Definition- ‘the extent to which a person’s behaviour – taking medication, following a diet and/or executing lifestyle changes – corresponds with agreedrecommendations from a healthcare provider’

Question 3

Non-adherence: a hidden problem

Answer 3

Doubts about medication and non-adherence are often hidden
•Clinicians assume ‘not my patients’
•Patients often reluctant to express doubts or non-adherence, because they fear this will be interpreted by the clinician as a ‘doubt in them’
•Patient may trust the clinician BUT not the treatment

Question 4

Cost of non-adherence

Answer 4

• Additional services and treatment (including drug reactions, resistance, worsening of symptoms)
• Decreases in quality of life / productivity
• E.g. poor adherence to medication estimated to cost up to $290 billion in USA each year (13% of healthcare expenditure)
• In UK, estimated costs of hospital admissions due to medication non-adherence is £36–196 million per year

Question 5

Ley’s cognitive hypothesis model (1989)

Answer 5

Understanding, memory and satisfaction&raquo_space;compliance

google diagram

Question 6

Horne’s (2001) Perceptions and practicalities approach

Answer 6

venn diagram
NON- INTENTIONAL NON-ADHERENCE (NINA)
-CAPACITY AND RESOURCE LIMITATIONS
-PRACTICAL BARRIERS

INTENTIONAL NON-ADHERENCE (INA)

• MOTIVATION AND BELIEFS
• PERCEPTUAL BARRIERS

Question 7

Factors that influence non-adherence 1

Answer 7

Factors related to the patient
•Lack of knowledge of treatment
•Cognitive, language, literacy difficulties
•Lack of resources
•Problematic health and treatment beliefs
•Lack of self-management and coping skills
•Stressful life events, mental health problems
•Lack of social support

Factors related to the treatment or disease
•High complexity / demands of the treatment
•Poor fit with patient’s lifestyle / activities
•Long duration of treatment
•Side-effects
•High cost of treatment
•Health problem not serious / threatening
•Lack of symptoms experienced by the patient •Symptoms of health problem interfere with adherence (e.g. memory)

Question 8

Factors that influence non-adherence 2

Answer 8

Factors related to the patient-provider relationship•Poor communication•Provider doesn’t adequately assess problems with treatment and/or adherence•Patient has difficulty discussing problems with treatment / adherence•Patient uncertain about providers ability to help•Patient lacks trust / comfort with provider•Patient and provider have differing conceptualisations / expectations about the problem / adherenceFactors related to the clinical setting•Lack of continuity or cohesiveness of care•Poor accessibility of services (availability of appointments / staff, hours of operation, waits for services)•Unfriendly or unhelpful staff