Adherence to medical advice

Question 1

Sub-topics

Answer 1

-Types of non-adherence and reasons why patients do not adhere
1. Types of non-adherence and problems caused by
non-adherence
2.Why patients don’t adhere: rational non-adherence
(Bulpitt)
3. The Health Belief Model (Becker)

• Measuring non-adherence
  1. Subjective: self-reports (Riekart and Droter)
  2. Objective: pill counting (Chung and Naya)
  3. Biochemical tests (Roth)
  4. Repeat Prescriptions (Sherman et al)

-Improving Adherence

• Improving practitioner style
  1. Behavioural techniques
  2. Money as an incentive (Yokley and Glenwick)
  3. The Funhaler (Watt et al)

Question 2

Types of non-adherence and problems caused by non-adherence

Answer 2

• causes may be related to the patient, treatment and the type of health care provider
• reasons could be intentional or non-intentional
• morbidity: the incidence of a disease across a population and/or geographic location during a predefined timeframe.
• mortality: the rate of death in a population

Question 3

Why patients don’t adhere: rational non-adherence

Answer 3

• Bulpitt
• rational choice theory is a framework for understanding and modeling why an individual will behave in a particular way
• one reason for non-adherence is actually a result of a well-considered and reasoned thought process that leads the patient to believe that non-adherence is a better choice of behaviour than adherence.
• Bulpitt: one reason is a rational ‘cost-benefit’ analysis
• concluded that the benefits form treating combined systolic and diastolic hypertension in elderly patients far outweigh the disadvantages.

Question 4

The Health Belief Model

Answer 4

• Becker
• aims to predict when a person will engage in preventative health behaviors such as stopping smoking, taking up exercise, attending check-ups and yearly screening tests
• the likelihood that individuals will follow medical advice depends directly on two assessments that they make: evaluating the threat and a cost-benefit analysis.
• several factors that can influence a person’s perceived threat of illness: perceived seriousness, susceptibility and cues to action, demographic variables eg: young obsese
• cost benefit assessment: whether the perceived benefits exceed the perceived benefits

Question 5

Measuring non-adherence

Answer 5

1. Subjective: self-reports (Riekart and Droter)
2. Objective: pill counting (Chung and Naya)
3. Biochemical tests (Roth)
4. Repeat Prescriptions (Sherman et al)

Question 6

Subjective:self-report

Answer 6

• Riekart and Droter
• wanted to examine the implications of non-participation in studies using self-report measures to investigate adherence to medical treatment for adolescents with diabetes.
• ages 11-18 who were living with at least one parent
• series of questionnaires and interviews
• both parents and participant were given a further questionnaire and were asked to mail it back
• 80/94 consented to participate
• 52 returned the follow-up questionnaire

Question 7

Objective: Pill counting

Answer 7

-Chung and Naya
-electronically assessed adherence with an oral asthma medication
-77, 32 M, 25 F, 18-55
-screening tets of 2-3 weeks and 12 week treatment
-56 tablets were dispensed in screw top bottles fitted
with a TrackCap medication event monitoring system device
-The system comprises of two parts: a standard plastic container and a lid containing a computer chip that registers the time at which the bottle is opened and closed
-median adherence calculated from TRackCap events was 89% but from pill counting it was 92%

Question 8

Biochemical Tests

Answer 8

• Roth
• levels of medication or its metabolites in blood or urine usually provide a reasonably good indication of the amount of medicine taken and clinical responses or side effects can be indications that medicine was taken.
• blood and urine samples
• empirical evidence has shown that adherence for prescribed medications is higher with frequent urine monitoring

Question 9

Repeat Prescriptions

Answer 9

• Sherman et al
• wanted to determine if a prescription refill history obtained by calling the patients’ pharmacies identified poor adherence with asthma medications more frequently than the doctor’s assessment from clinical appointments
• 116 children with asthma interviewed with their parents
• operationalized by calculating the no. of doses refilled divided by the no. of doses prescribed over a period up to 365 days
• info provided by pharmacies were 92% correct
• mean adherence: 72%, 61%, 38% for 3 diff inhalers

Question 10

Improving Practioner Style

Answer 10

1. Behavioral techniques
2. Money as an incentive (Yokley and Glenwick)
3. The Funhaler (Watt et al)

Question 11

Behavioral techniques

Answer 11

• changing habits using classical conditioning
• using positive reinforcements to encourage positive behavior
• using role models to show the imp of adherence of medical requests.

Question 12

Money as an incentive

Answer 12

• Yokley and Glenwick
• four conditions: a mailed general prompt, a mailed specific prompt, a mailed specific prompt plus expanded clinic hours and a mailed specific prompt plus a monetary incentive

Question 13

Money as an incentive

Answer 13

• Yokley and Glenwick
• four conditions: a mailed general prompt, a mailed specific prompt, a mailed specific prompt plus expanded clinic hours and a mailed specific prompt plus a monetary incentive
• conducted on the entire population of a medium sized midwest city (approx 300000)
• target population: children of 5 or younger
• monetary incentive: the biggest impact
• specific prompts also effective and has reduced costs than the monetary prompt

Question 14

The Funhaler

Answer 14

• Watt et al
• Funhaler: incorporates incentive toys to a child’s inhaler
• if the correct breathing technique is used, the child is rewarded by a fun whistle sound and a spinning toy within the inhaler.
• when surveyed at random, 60% more children adhered to what was supposed to be done