Adherence to treatment Flashcards
Definition of non-adherence
The extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.
How do you measure adherance?
- Self report questionnaire
- Self monitoring (diary)
- Pill counts
- Frequency of dispensing (pharmacy data)
- Mechanical measures (microchips in bottle tops, etc)
- Biochem indicators (blood or urine levels of drug)
- Proxy measure (Clinical or other outcome symptoms,)
What is the impact of non-adherance?
Non-adherence can lead to disease progression or delayed recovery, more complications and increased morbidity/mortality, more hospitalisations.
Personal costs: increased disability/decreased quality of life. Patient may have to retire early, rely on a carer etc
Societal costs: higher healthcare costs, more aggressive treatment, benefit payments.
What are the different types of non-adherance?
Intentional non-adherence
Making a decision not to take all of the doses as prescribed – or take too much or at the wrong time.
The decision can change over time depending on several factors e.g. symptoms, health education, social influence, experience etc
Unintentional non-adherence
Capacity/functional limitations - forgetting
Resource limitations
What are the determinants of intentional non-adherence?
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Motivation
Influenced by:
* Negative emotion
* Social support
* Relationship with HCP - Illness Perceptions
- Treatment Perceptions
Intentional non-adherence model?
What does the patient consider in intentional non-adherance?
Treatment perceptions influence
Necessity - How much do I need this medicine?
Concerns - What are the potential problems of taking this medicine?
Balance of treatment beliefs and risk of non-adherence
What are other determinants of intentional non-adherance?
Psychosocial factors – social and family support
Disease/Healthcare factors – treatment regimen, practical barriers
Communication poor practitioner-patient communication
What are psychological interventions used to improve non-adherence?
- Specific action plans or implementation intentions
- Electronic reminders
- Smartphone apps
- Medication monitors
Description of the patient centred approach?
Applied psychology to:
Medication reviews
Self-management plans
Patient centred care supplemented with use of decision aids
Strategies for improving adherence
- Specific action plans or implementation intentions
- Electronic reminders
- Smartphone apps
- Medication monitors
- Removing barriers (Unintentional)
- Repeat prescription, financial, social
- Improving communication
- Knowledge, memory, instruction
- Identifying maladaptive illness and treatment perceptions and modifying them (Intentional)
E.g. symptoms, timeline, consequences, drug concerns
Why is better for interventions to be postive?
- People are motivated to maintain a global sense of self-worth.
- Health risk information might be rejected if threatening to self
- Self-affirming manipulations reduce resistance to information
Improving adherance strategy as a doctor
- Anticipate non-adherence (normalise)
- Understand beliefs about treatment & expectations
- Check unintentional barriers to adherence
Memory cues can help – “take with food”
Medicine organisers and text reminders - The doctor patient relationship is very important - shared collaborative decision making.
- The quality of the communication will impact on memory and satisfaction
How does partnership with the patient come into play with adherance
- Healthcare providers have a duty to help patients make treatment decisions that are informed by an accurate
understanding of the likely benefits and risks of treatment … rather than by mistaken beliefs about their illness and the treatment - Informing should be an active process. It is not just presenting the facts or dictating “must-dos”.
- Consider a patient’s beliefs and whether beliefs are a barrier to an unbiased interpretation of the evidence
- Normalising non-adherence ◦ “A lot of people have trouble taking their medications regularly”
- Establishing specific difficulties ◦ “Do you find it more difficult to remember at weekends or when you’re on holiday?” “Do you experience any side effects? How have you coped with them?”
- Check knowledge of the medication regimen ◦ “Do you have a routine for taking your medication?”
