Adherence and Concordance

Question 1

What is the definition of adherence?

Answer 1

The extent to which the patient’s behaviour matches agreed recommendations from the prescriber

Question 2

What is the definition of compliance?

Answer 2

The extent to which the patient’s behaviour matches the prescriber’s recommendations

Question 3

What is the definition of concordance?

Answer 3

concordance is a belief that decisions about medicines should be shared by prescriber and patient so that they can arrive at a harmonious agreement
This agreement should also recognise the importance of the patient’s opinions and wishes in deciding when, how, and whether they take their medicine.

Non-concordant consultations that fail to take account of the patient’s views are more likely to result in therapeutic decisions that are not compatible with the patient’s perspective - resulting in an increased risk of non-adherence.

Question 4

Which factors effect adherence?

Answer 4

• Social/economic factors (e.g. age, gender, an inability to pay for medicines)
• Social/economic factors (e.g. age, gender, an inability to pay for medicines)
• Therapy-related factors (e.g. adverse effects of medicines, complexity of drug regimens)
• Patient-related factors (e.g. patient disagreement with the necessity for treatment, low self-esteem)
• Condition-related factors (e.g. dysphagia in myasthenia gravis)

Question 5

What are some side effects of statins? How does the creatinine kinase effect its use?

Answer 5

Muscle effects - myalgia, myositis and myopathy

The risk is increased if the statin is prescribed at a high dose or if it is prescribed in combination with a fibrate, macrolide antibaterial or certain calcium-channel blockers.

Treatment should be discontinued if creatine kinase is 5 times the upper limit of normal or if symptoms are severe.

Question 6

Which drugs can cause gout?

Answer 6

Thiazide diuretics: can cause hyperuricaemia

salicylates, pyrazinamide, ethambutol, nicotinic acid, cyclosporin

Question 7

What are the side effects of Prochlorperazine?

Answer 7

cause Extra Pyramidal Side-Effects (EPSE) such as dystonia. Should EPSE occur with prochlorperazine, treatment should be reviewed and switched if possible.

Question 8

Which drug can cause mood changes?

Answer 8

Systemic corticosteroids