adherence to medical services

Question 1

types of adherence

Answer 1

adherence
- how much a person’s behaviour follows the advice of a medical professional says and what’s agreed on

non adherence
- when patient fails to follow treatment or attend appointment

types of non adherence

1. primary non adherence
   - when a doctor prescribes medication but medication was never collected by doctor
2. non persistant
   - when patient starts to take the medication but stops without the advice from medical professional
3. non conforming
   - involves ways in which the medication isn’t take as perscribed

problems caused by non adherence
- waste of medication
- waste of time due to missed appointment
- increased use of medical resources
- progression of illness
- decreased functioning ability
- impact on medical research

Question 2

example study (laba et al) reasons why people do not adhere

Answer 2

rational non-adherence
- people do not adhere due to the deliberate decision to adjust medication

laba et al
- aim to investigate which factors contribute the most to rational non adherence
- online survey with 3 sessions. 1st session asked patients about their current medication, attitudes towards medication. 2nd session was was a discrete choice experiment, 3rd session asked about background information of participants
- they were asked to imagine taking 2 medications and choose which of one they would be most happy to continue taking
- participants were given range of factors to consider about the medication
- this included symptom severity, alcohol restrictions, cost of medication, chance of early death of illness
- results showed that symptom severity, alcohol restrictions did not sinificantly affect adherence
- cost of medication is a significant factor for those without private insurance
- participants are more likely to take the medication if it was onlt needed to be taken once per day.

Question 3

measure of adherence (objective)

Answer 3

medical dispensers
- allows tablet to be placed in container for each day of a week
- at the end of each week, can count how many tablets are there left as a simple measrue of non-adherence

pill counting
- requires patient to bring in all medication to appointment
- measures the amount of medication that they had taken, count how many pills are ther left
- however, does not know whether the patient had actually taken the medication or not
- cannot track the pattern of patient taking the medication

example study : chung and naya
- investigated the effectiveness of electronically measuring adherence and compliance in asthma patients
- MEM devices used to track the date and time when the cap was removed
- days was catergorised into 3 categories
- internal insufficient adherence : days with 2 events with less thatn 8 hours apart
- over adherence : days with more than 2 events
- no adherence : days with no events
- under adherence : days with only 1 event
- results showed that compliance was consistently high throughout 12 weeks, with adherence slightly lower than compliance
- concluded that track cap is effective in measuring compliance and adherence

blood and urine test
- most accurate and objective measure of non adherence
- blood and urine sample shows the level of certain drugs in patient’s body
- acts as an measure of adherence to treatment given, medication
- highly valid and reliable, does not rely on patient’s honesty
- but it is fairly expensive and time consuming

Question 4

measure of adherence (subjective)

Answer 4

riekert and drotar (example study)
- used subjective measure to measure adherence
- teenagers aged 11-19 with type 1 diabetes and lived with at least one parents were approached
- parents completed a questionnaire about demographics information
- teenagers completed a semi-structured interviews resultingin a adherence score
- they were given a questionnaire and were asked to complete it and return using a envelop
- they were categorised into three groups including the non completers, completers, and non consenters
- those who failed to return their questionnaire had siginificantly lowere adherence score
- concluded that those who returned their questionnaire are more likely to adhere to medical advice

subjective measures example
- medical adherence measure
- semi - structured interview
- tests knowledge of patients on the treatment prescribed, and self reported adherence
- emphasise on a strong patient practioner relationship
- give advice and support to increase adherence and patient care
- allows insight of patient’s feeling towards the treatment given
- however, some patients may feel guilty to report

Question 5

improving adherence

Answer 5

individual behavioural technique

contracts
- patient and medical practitioners discuss and clarify the requirements of taking the medication
- patient signs the contract to agree that they will adhere to the medication

prompts
- prompts through medication box, text messages, phone calls
- improve adherence where non adherence is caused by forgetting to take the medication

customising treatment
- adjust treatment to best fit the patient’s lifestyle
- make the treatment more convienient and easier to adhere
- adjust the treatment to reduce side effects

Question 6

key study : yorkley and glenwick

Answer 6

• to evaluate the effectiveness of 4 different conditions in motivating parents to get their preschool children immunisied
• 4 different conditions in total, including the general mail prompt, specific mail prompt, specific mail prompt and increased access, specific mail prompt and monetary incentive
• the general mail prompt group received general immunisation infomation, urging parents to get their children’s immunisation up to date, without any personal information given
• the specific mail prompt group reveived name of target child, as well as specific immunisation needed, along with clinic’s opening hours and location
• the specific mail prompt group and increased access group received the specific mail prompt, and clinic’s out of sessions hours were given. parents were told that they can drop off their children at free childcare service for the whole session
• the specific prompt and monetary incentive group received the specific prompt, as well as additional information about a cash lottery which included 3 cash tickets that needed to be handed in when the child is immunisied.
• control group no contact, only telephone
• siginificant difference between the groups in terms of total number of target child immunisied, number of target child attending clinic for any reason, and total number of immunisation given
• most cost effective method in the long term is the specific mail prompt
• largest impact was the monetary incentive, followed by increased access, specific prompt, general prompt and control
• the monetary incentive and increased access group has created the largest increase in terms of the number of immunisation given

Question 7

example study (chanley et al)
improving adherence

Answer 7

• aimed to compare adherence in children with asthma using the traditional spacer and funhaler
• parents were contacted and completed a questionnaire about attitudes to medication, frequency of medication
• patients were invited to use the funhaler for 2 weeks and completed the same questionniare
• results showed that more patients medicated on the previous day using the funhaler compared to patients usiung the traditional spacer
• results also showed that more patients using the funhaler completed the recommended 4 or more breath cycle than patients using the traditional spacer
• more patients reported pleasure using the funhaler compared to patient using the traditional spacer

Question 8

reasons why people do not adhere (health belief model)

Answer 8

perceived severity
- people are less likely to adhere to medication for a minor illness than a more serous one

percieved susceptibility
- people are less likely to adhere to medication if they feel like they areparticularly not at risk

percieved barriers
- people are less likely to adhere to medication if they percieved barrier in place for example discomfort, inconvinient

perceived benefits
- people are less likely to adhere if they feel less confident that the treatment will work out

cues to action
- people are more likely to adhere to medication if they are exposed to a trigger, for example a love one dying from a smililar condition

self efficacy
- people are more likely to adhere to medication if they feel confident that they could keep up with the treatment plan