Adherence to treatment Flashcards
doctor centered consultation style
paternalistic
tightly controlled interviewing style aimed at reaching an organic diagnosis based on biomedical model
patient centered consultation style
less authoritarian, encourages patient to discuss their own feelings and concerns
open questioning, interested in psychosocial aspects of illness
shared decision making, self management
compliance definition
degree or extent of conformity to the recommendations about day to day treatment by the provider with respect to the timing, dosage and frequency
adherence
extent to the patients behaviour matches agreed recommendations from the prescriber
how does adherence emphasise the need for agreement
preventative action
keeping medical appointments
following self-care advice
caring for wound after surgery
taking medication as directed
measuring adherence
patient estimation
practitioner estimation
pill or quantity accounting
biomedical tests
mechanical methods
calculate difference between number of prescriptions issued and number presented at chemist
why is non-adherence a problem
medical advice is considered essential for health outcomes
people who do not adhere may be putting their health are further risk
cost implications of non-adherence
amount spent on health education/promotion
non-adherence may lead to repeat consultations, waste of expensive drugs and/or days off work
small percentage of people may end up needing more expensive treatment due to non-adherence
why do some patients fail to follow treatment advice
social factors
psychological factors
treatment factors
social factors
low levels of education
low levels of social support
young women
psychological factors
increased anxiety and depression
non-acceptance of illness
avoidance coping styles
perceived stigma of condition
negative beliefs about medicines
treatment factors
misunderstandings about treatment
complexity of regimen
side effects
poor relationship or communication between doctor and patient
match/mis-match with desired level of control
key factors identified in the WHO
social and economic factors: age and race, economic status, medication cost
cultural values health system and healthcare term-related factors
therapy-related factors: length of treatment, complexity of treatment, unwanted side effects
condition related factors, comorbidities, level of disability, acuity and severity of the condition
patient-related factors: forgetfulness, treatment anxiety, misunderstood instructions, beliefs about medicines such as fear of becoming dependent on medication
lay evaluation of medicines
weighing up costs and benefits including: adverse. effects, acceptability of regimen
stopping medicines and seeing what happens
evidence base for a behavioural approach to medicine adherence is growing and interventions such as
health coaching
motivational interviewing
cognitive behavioural therapy
used to support the behavioural aspects of medicines adherence
intervening in adherence
explore
educate
empower
enable
explore
what the patient wants to know about their medicines and follow their agenda
educate
patients about what they want to know and check understanding
empower
patients to take ongoing responsibility for medicines taking
enable
behavioural change through discussion of practical issues around medicine taking
Ley’s model, 3 functions of adherence
understanding
memory
satisfaction
research in cognitive psychology for memory
memory for verbal information Is poor
patients unlikely to remember all the information they are given
primacy effect- early information is remembered best
high anxiety interferes with recall
information the patients perceives as being important may not coincide with what the doctor thinks
strategies for increasing adherence
Tang and Newcomb
system of producing personalised computer print out of relevant information arising from consultation
patients who received felt their understanding of their care improved, enhanced relationship with providers, improved satisfaction with care and motivated them to adhere to treatment plans
concordance
involves agreement between the patient and doctor about whether, how and when medical treatment will be used
what do both compliance and adherence focus on
patient-behaviour taking during medication taking
power relationship in compliance
doctor is authorative and powerful
patients is powerless, passive and appropriately obedient
what does concordance highlight
the processes that underlie medication taking
equal and effective therapeutic relationship
supports the patient during the entire course of receiving long term treatment
medical consultation and patients outcomes
disparities amongst practices can have direct and indirect consequences
adherence significantly impacted by doctor patient interactions
shared decision making
NICE guidelines support the role of healthcare professionals in providing care in partnership with patients
taking account of individual needs and preferences
ensuring patients can make informed decisions about their care and treatment
consisting of open discussions with patient, imparting information and supporting patients on long-term medication or treatment pathway
patient centered approach
explores patients main reasons for the visit
concerns and need for information
seeks integrated understanding of patients world
finds common ground on problem and mutually agrees on management
enhances preventions and health promotion
enhances continuing relationship between patient and doctor
