Adherence to medical advice

Question 1

what is adherence

Answer 1

Adherence to medical advice is when the health behavior of a patient corresponds to the medical advice given by their practitioner.

Question 2

what is non-adherence

Answer 2

Non adherence is when the patient does not follow medical advice, when the patient does not adhere to medical advice it has several repercussions to the health of the patient

Question 3

What are the types on non-adherence

Answer 3

1. Primary non-adherence - here patients get a prescription from the doctor but fail to collect the medication from the pharmacy.
2. Non-persistence - here the patient starts to take the medication but stop prematurely without being advised to do so by the doctor.
3. Non-conforming - here the medication is not taken as prescribed eg. Incorrect doses, missing doses, Incorrect timings. Etc.

Question 4

What are the repercussions to non-adherence

Answer 4

1. Lower quality of life - Here the suffering caused by the illness in the form of pain disabilities etc. May lower the quality of life for the sufferers.
2. Reduced function of abilities - due to non-adherence, the decese symptoms may worsen leading to functional impairment.
3. Increased use of medical facilities - if the condition worsens more hospital visits and admissions may be recommended by the practitioner.
4. Progression of illness - worsening of symptoms may lead to possible hospitalization, ore invasive treatments and sometimes death.

Question 5

What are the reasons for non-adherence

Answer 5

1. Rational non-adherence (rational choice therapy)
2. HBM (health beliefs model)

Question 6

Describe rational non-adherence

Answer 6

Rational non-adherence (rational choice therapy)

• Patients fail to follow medical advice because they have a good reason for not doing so. According to sarafino (2006), some of the reasons for rational non-adherence include:
1. The patient believe that the treatment will not work. (Belief problems)
2. The side effects of the medication/treatment is extremely unpleasant.
3. You can’t afford the treatment.
4. Wanting to see if the illness will go away without medication.

Question 7

Describe the study by Bulpith and fletcher

Answer 7

• In this study the researchers wanted to know whether the elderly would contend with the unpleasant side-effects of the hypertensive drugs and follow the medical advice or whether they would drop out of the treatment regime prematurely, for fear of the unpleasant side-effects.
• Failure to use hypertensive drugs would mean the patients would contend with diseases such as heart disease, unstable Angina, or even death.
• Swallowing the medication would mean the elderly would have to contend with the unpleasant side-effects such as gout,dizziness, impotence, poor ejaculation, swelling and pain in the joints.
• Results showed that 8% of the men stopped taking the medication due to sexual problem, 15% of the men stopped due to tiredness, sexual problems and gout.
• Conclusion - when the cost of taking medication out way the benefits, then individuals will make a rational choice not to take the medication.

Question 8

Describe the study by laba et al

Answer 8

AIM:

• To investigate whether factors relating to specific medicines and patient backgrounds contribute to non-adherence.

SAMPLE:

• 1,668 invited to participate, however only 244 commenced the questionnaire and only 161 actually completed it.
• Hence sample is n=161.
• They were all from Australian adults who were all English speaking
• 45% were male 55% were female, they had a mean age of 57 years.

PROCEDURE:

• A survey was used to gather data, the survey had 3 sections.
• Section 1: asked questions about current medication use and attitude towards medication.
• Section 2: the discreet choice experiment - was conducted through a web enabled online survey. Task include :
1. Imagine you are currently taking 2 medications for different long term conditions. Which of those 2 medications would you be happiest to continue consuming, medication A or B? For each medication the patient would be provided with information regarding : symptom severity, symptoms frequency while on medication, chances of early death from the illness while on medication, alcohol restrictions, monthly cost etc. Which one would you prefer?

• Section 3 : data analysis.

RESULTS:

• Symptoms severity and alcohol restrictions did not have a significant effect in the decision to continue with medication A or B
• Monthly cost for medication was observed to be a significant factor to non-adherence only for those who did not have a private insurance.
• Participants would be more willing to continue the medication, treatment if it only needed to be taken once a day compared to 4 times a day. However they would prefer to continue with the 4 times a day regime if it reduced the risk of unwanted side-effects in the future by 20%
• The risk of current side-effects was considered to be more important than future risks side-effects.

CONCLUSION:

• Various factors relating to cost, convenience and risk of death, affect the patients adherence to the treatment regime.

Question 9

Describe the health belief model

Answer 9

• The HBM was developed to explain why people do not make certain preventive health choices eg. Exercising.
• The decision to engage in a health behavior depends on the outcomes of 2 Assessments :
1. Assessment of threat. Perceived severity (the more severe the symptoms of a disease, the more likely…), percived vulnerability (the more at risk a patient is to a disease, the more likely they will follow the medical advice), cues to action (demographic variables eg. Age, sex, inheritance.) Perceived benefits and barriers (cost, increase in quality of life,
2. Assessment of cost and benefits of engaging in a health behavior.

Question 10

Explain a self report as a subjective measure of non-adherence

Question 11

What are the subjective measures of non-adherence

Question 12

Evaluate a self report as a measure

Question 13

Describe a clinical interview as a measure of non-adherence

Question 14

Describe the example study by rickert and drotar

Question 15

Evaluate the clinical interview

Question 16

Evaluate the study

Question 17

What are the objective measures of non-adherence

Question 18

Describe medical dispensers as objective measure

Question 19

Evaluate medical dispensers as a objective measure

Question 20

Describe pill counting as a objective measure

Question 21

Evaluate pill counting as a objective measure

Question 22

Describe the example study by Chung and Naya

Question 23

Evaluate the study by Chung and naya

Question 24

What are the ways of improving adherence

Question 25

Describe the study by chaney et al