Adherence to medical advice

Question 1

Define adherence.

Answer 1

The degree to which the person’s behaviour corresponds with the agreed recommendations from a healthcare provider.

Question 2

What are the two types of non-adherence?

Answer 2

Failure to follow treatments.

Failure to attend appointments.

Question 3

Describe the three types of failure to follow treatments.

Answer 3

Primary non-adherence. It happens when the patient does not collect the medication that they have been prescribed.

Non-persistence. It happens when the patient stops taking their medications without being advised to do so by a medical professional.

Non-conforming. It happens when medication is not taken as prescribed by the patient.

Question 4

State the problems caused by non-adherence.

Answer 4

Waste of medication.

Time lost due to missed appointments.

Progression of illness.

Increased use of medical resources.

Reduced functional abilities.

Lower quality of life.

Impact on medical research.

Question 5

Describe the aims of Laba et al. (2012).

Answer 5

To find out which factors contribute the most to rational non-adherence.

To investigate whether factors relating to specific medicine and patient background contribute to non-adherence.

Question 6

Describe the sample of Laba et al. (2012).

Answer 6

Online sampling system was used to collect a representative sample of 161 Australian participants in terms of age, gender, education level and income.

Question 7

Describe the procedure of Laba et al. (2012).

Answer 7

An online survey with three sections was used.

Section one asked about current medication use and attitudes towards medication.

Section two asked about the Discrete Choice Experiment (DCE).

Section 3 asked about background information of the participant.

Question 8

Describe the findings of Laba et al. (2012).

Answer 8

Participants’ background did not have a significant effect on adherence.

Cost of medication is a significant factor only for those who do not have private medical insurance.

Most participants considered harms to be of greater importance than benefits when making decisions about adherence.

Medication’s ability to reduce risk of death was seen to be more important than the reduction in symptom frequency.

Question 9

State some measures of non-adherence.

Answer 9

Subjective measures such as clinical interview and Medical Adherence Measure (MAM)

Objective measures such as medical dispensers, pill counting and TrackCap.

Biological measures such as blood and urine samples.

Question 10

Describe the aim of Chung and Naya (2000).

Answer 10

To investigate the effectiveness of electronically measuring adherence and compliance to medication in asthma patients.

Question 11

Describe the sample of Chung and Naya (2000).

Answer 11

57 asthma patients.

Question 12

Describe the procedure of Chung and Naya (2000).

Answer 12

Patients were given three weeks worth of tablets and instructed to take one tablet in the morning and another one in the evening, approximately 12 hours apart.

Patients were told that compliance was being measured but not how it would be measured.

Bottles of medication are fitted with TrackCap medication event monitoring system (MEMS).

Patients return the unused tablets and bottle at the end of three weeks to be counted.

This is repeated a few times in a 12 week trial.

Question 13

Describe the conclusion of Chung and Naya (2000).

Answer 13

TrackCap is an accurate measure of compliance and adherence to medication.

Question 14

Describe the difference between compliance and adherence.

Answer 14

Compliance refers to a passive following of medical orders, whereas adherence refers to more of a collaboration between doctor and patient, and relates to the patient fully understanding medical advice and following it accurately, even adjusting lifestyle to meet requirements.

Question 15

Describe the study by Chaney et al. (2004).

Answer 15

To compare the adherence of children with asthma using the Funhaler to those using traditional spacer.

Funhaler is a standard inhaler and spacer but with a whistle and toy added.

Sample consisted of 32 children aged 1.5 to 6 years who were using a traditional inhaler and standard spacer.

Parents completed a closed questionnaire about attitudes and adherence to the recommended treatment and frequency of medication.

Participants were given the Funhaler to use for two weeks and then the same questionnaire were administered again.

Concludes that Funhaler is a very effective device in improving adherence and experiences of children with asthma and their parents alike.

Question 16

Describe the aim of Yokley and Glenwick (1984).

Answer 16

To evaluate the effectiveness of four conditions for motivating parents to immunise their preschool children.

Four conditions were:
1. A mailed general prompt
2. A mailed specific prompt
3. A mailed specific prompt and expanded clinic hours to increase access and convenience.
4. A mailed specific prompt and monetary incentive, in the form of cash lottery.

Question 17

Describe the hypothesis of Yokley and Glenwick (1984).

Answer 17

Greatest impact would be specific prompt with monetary incentive, followed by specific prompt and increased access, then the specific prompt alone and lastly, the general prompt.

Question 18

Describe the procedure of Yokley and Glenwick (1984).

Answer 18

“General prompt” group was mailed a prompt with general immunisation information.

The “specific prompt” group was mailed a prompt that named the target child, as well as the specific immunisations they required, and giving the clinic’s location and hours.

“Increased access” group received the specific prompt, as well
as information about extra out-of-hours sessions at the clinic, and parents were told they could leave their children at the free childcare if they wished.

The “monetary incentive” group received the specific prompt as well as information about a cash lottery that offered three cash prize draws, requiring a ticket to be handed in when the child was taken for their immunisations.

There were two control groups: the contact control group received a telephone call requesting information about immunisations and demographics but not giving any prompts, and the no-contact control group were not contacted at all during the study.

There were three dependent measures: the number of target children receiving one or more immunisations, the number of
target children attending the clinic for any reason, and the total number of immunisations received by target children.

The immediate effect of all conditions was measured after two weeks.

A follow-up was done at two and three months later.

Question 19

Describe the findings of Yokley and Glenwick (1984).

Answer 19

Hypothesis is accepted.

Findings remained significant at both two and three months follow up.