Adherence to treatment

Question 1

doctor centered consultation style

Answer 1

paternalistic
tightly controlled interviewing style aimed at reaching an organic diagnosis based on biomedical model

Question 2

patient centered consultation style

Answer 2

less authoritarian, encourages patient to discuss their own feelings and concerns
open questioning, interested in psychosocial aspects of illness
shared decision making, self management

Question 3

compliance definition

Answer 3

degree or extent of conformity to the recommendations about day to day treatment by the provider with respect to the timing, dosage and frequency

Question 4

adherence

Answer 4

extent to the patients behaviour matches agreed recommendations from the prescriber

Question 5

how does adherence emphasise the need for agreement

Answer 5

preventative action
keeping medical appointments
following self-care advice
caring for wound after surgery
taking medication as directed

Question 6

measuring adherence

Answer 6

patient estimation
practitioner estimation
pill or quantity accounting
biomedical tests
mechanical methods
calculate difference between number of prescriptions issued and number presented at chemist

Question 7

why is non-adherence a problem

Answer 7

medical advice is considered essential for health outcomes
people who do not adhere may be putting their health are further risk

Question 8

cost implications of non-adherence

Answer 8

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

Question 9

why do some patients fail to follow treatment advice

Answer 9

social factors
psychological factors
treatment factors

Question 10

social factors

Answer 10

low levels of education
low levels of social support
young women

Question 11

psychological factors

Answer 11

increased anxiety and depression
non-acceptance of illness
avoidance coping styles
perceived stigma of condition
negative beliefs about medicines

Question 12

treatment factors

Answer 12

misunderstandings about treatment
complexity of regimen
side effects
poor relationship or communication between doctor and patient
match/mis-match with desired level of control

Question 13

key factors identified in the WHO

Answer 13

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

Question 14

lay evaluation of medicines

Answer 14

weighing up costs and benefits including: adverse. effects, acceptability of regimen
stopping medicines and seeing what happens

Question 15

evidence base for a behavioural approach to medicine adherence is growing and interventions such as

Answer 15

health coaching
motivational interviewing
cognitive behavioural therapy
used to support the behavioural aspects of medicines adherence

Question 16

intervening in adherence

Answer 16

explore
educate
empower
enable

Question 17

explore

Answer 17

what the patient wants to know about their medicines and follow their agenda

Question 18

educate

Answer 18

patients about what they want to know and check understanding

Question 19

empower

Answer 19

patients to take ongoing responsibility for medicines taking

Question 20

enable

Answer 20

behavioural change through discussion of practical issues around medicine taking

Question 21

Ley’s model, 3 functions of adherence

Answer 21

understanding
memory
satisfaction

Question 22

research in cognitive psychology for memory

Answer 22

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

Question 23

strategies for increasing adherence

Answer 23

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

Question 24

concordance

Answer 24

involves agreement between the patient and doctor about whether, how and when medical treatment will be used

Question 25

what do both compliance and adherence focus on

Answer 25

patient-behaviour taking during medication taking

Question 26

power relationship in compliance

Answer 26

doctor is authorative and powerful
patients is powerless, passive and appropriately obedient

Question 27

what does concordance highlight

Answer 27

the processes that underlie medication taking
equal and effective therapeutic relationship
supports the patient during the entire course of receiving long term treatment

Question 28

medical consultation and patients outcomes

Answer 28

disparities amongst practices can have direct and indirect consequences
adherence significantly impacted by doctor patient interactions

Question 29

shared decision making

Answer 29

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

Question 30

patient centered approach

Answer 30

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