Adherence and Concordance

Question 1

Define Adherence

Answer 1

when the patient’s behaviour coincides with the clinical prescription

Question 2

Define Compliance

Answer 2

to do what the doctor orders

Question 3

Define Concordance

Answer 3

the prescriber and patient negotiate as equals to agree a plan of treatment, respecting the beliefs + wishes of the patient in determining whether, when and how the medicines are to be taken.

Question 4

How can you measure non-adherence?

Answer 4

1. Hawthorne effect - individuals modify an aspect of their behaviour in response to their awareness of being observed
   - Patients often reluctant to admit non-adherence

Question 5

How do you measure adherence using direct methods?

Answer 5

• Measuring drug conc. in bodily fluids

- Observation

Question 6

How do you measure adherence using indirect methods?

Answer 6

• Tablet Counts
• Electronic monitors (tell you when a container has been opened)
• Interview patients
• Dispensing records

Question 7

Why is it difficult to to know at what point non-adherence happens?

Answer 7

Not just forgetting one tablet one day in a year. We don’t exactly know. Each drug and each patient is different.

Question 8

What are the 2 types of non-adherence?

Answer 8

1. Intentional

2. Non-intentional

Question 9

What is intentional non-adherence?

Answer 9

Patients deliberately don’t take the medication as prescribed.

• Misuse = take too much medicine
• Taking too little/no medicine = unpleasant to take, side effects, don’t like taking medicines

Question 10

What is non-intentional non-adherence?

Answer 10

Patients unintentionally don’t take their medicine as prescribed.

• Poor understanding = take too much medicine
• Take too little/no medicine = forget, access, unable to use, can’t afford

Question 11

Who are the most non-adherent patients?

Answer 11

We don’t actually know. There’s no clear link between adherence, age, gender, social class or educational status. BUT most patients will be non-adherent at some point.

Question 12

What 3 factors can affect adherence?

Answer 12

1. Dosage Frequency
2. Length of treatment
3. Nature of the disease

Question 13

What are 3 main ways we can improve adherence?

Answer 13

1. Use combination products
   e. g. co-codamol containing codeine + paracetamol
2. Change the formulation
   e. g. using modified-release products, like Diclofenac rather than 25mg 3 times a day, use 75mg SR once a day
3. Change the drug
   e. g. to a once daily drug

Question 14

What adjustments can be made for people with disabilities when dispensing?

Answer 14

• Large print labels
• Easy-open containers
• Medication reminder charts
• Multi-compartment compliance aid
• Talking labels

Question 15

Why is it important to recognise people’s beliefs for patient adherence?

Answer 15

So that adjustments can be made and that patients feel more confident and safer in taking their medicines.
e.g. pregnant women might believe drugs are bad for the baby so stop taking

Question 16

How can Pharmacists achieve concordance?

Answer 16

Talk to the patients regarding their views with condition and treatment.

• Don’t assume a medicine is desired
• Ask the patient the kind of treatment they’d prefer
• Establish the patient’s general attitude to medicines
• Determine whether social context will affect adherence e.g. work

Question 17

What should you ensure the patient can do before supplying a medicine?

Answer 17

• Understands the purpose, benefits + risk of treatment

- Is able to comply (clear instructions, simple regimen + appropriately trained)