Adherence To Treatment

Question 1

Define compliance.

Answer 1

Compliance is the extent to which the patient complies with medical advice.

Question 2

Define adherence.

Answer 2

The extent to which patient behaviour coincides with medical advice.

Question 3

What is the difference between compliance and adherence?

Answer 3

Compliance involves the patient “doing as they are told”, adherence takes into account the patients right to choose to what extent they follow the advice.

(Often used interchangeably in practice however)

Question 4

Define concordance.

Answer 4

Negotiation between the patient and doctor over treatment regimes.

Question 5

What does concordance imply?

Answer 5

That the patient is active and in partnership with the doctor

Question 6

What does concordance allow for?

Answer 6

The patient’s beliefs and priorities to be respected and for decisions to be shared

Question 7

How may concordance lead to adherence?

Answer 7

• The patient has involvement and shared ownership of decisions.
• Patient’s beliefs, expectations, lifestyle and priorities are considered.
• Barriers to adherence can be addressed.
• Promotes trust and satisfaction with care.

Question 8

What is the norm in terms of adherence to medical advice?

Answer 8

Non-adherence is the norm

Question 9

What percentage of chronically ill patients do NOT adhere to medical advice?

Answer 9

50%

Question 10

What percentage of hospitals admissions of chronically ill patients are due to non-adherence?

Answer 10

10-25%

Question 11

What is the percentage of non-adherence to medication?

Answer 11

~21%

Question 12

What is the percentage of non-adherence to exercise?

Answer 12

~28%

Question 13

What is the percentage of non-adherence to diet?

Answer 13

~42%

Question 14

Which diseases have the highest rates of adherence?

Answer 14

HIV, arthritis, GI disorders, and cancer

Question 15

Which diseases have the highest rates of non-adherence?

Answer 15

Pulmonary disease, diabetes, and sleep disorders

Question 16

Give two examples of direct measures of adherence

Answer 16

Urine or blood test

Observation (e.g. Of consumption)

Question 17

What are the advantages of urine or blood tests?

Answer 17

Provides a direct measure of consumption/adherence

Question 18

What are the disadvantages of urine or blood tests?

Answer 18

Expensive

Limited to use in clinical practice

Invasive

Question 19

What are the advantages of direct observation of adherence?

Answer 19

Provides a direct measure of consumption/adherence

Question 20

What are the disadvantages of direct observation of adherence?

Answer 20

Expensive

Limited to use in clinical practice

Invasive

Question 21

Give four examples of indirect measures of adherence

Answer 21

Pill counts

Mechanical or electrical measures of dose dispensing

Patient self-report

Second-hand reports

Question 22

What is the advantage of pill counts?

Answer 22

More objective than self / other-reports

Question 23

What is the disadvantage of pill counts?

Answer 23

Still subject to inaccuracy (e.g. Lost pills)

Question 24

What are the advantages of mechanical or electrical measures of dose dispensing?

Answer 24

Objectively measures whether a dose has been dispensed

More accurate than other indirect measures

Question 25

What is the disadvantage of mechanical or electrical measures of dose dispensing?

Answer 25

Doesn't measure if the dispensed medication was actually taken

Question 26

What are the advantages of patient self-report?

Answer 26

Easy to obtain Inexpensive

Question 27

What are the disadvantages of patient self-reports?

Answer 27

Prone to inaccuracies/bias Tendency to over-report adherence

Question 28

What are the advantages of second-hand reports?

Answer 28

Similar to self-reports

Question 29

What are the disadvantages of second-hand reports?

Answer 29

Similar to self-reports Also depends on familiarity with patient

Question 30

What are the main contributing factors for non-adherence?

Answer 30

Illness factors Treatment factors Patient factors Psychosocial factors Healthcare factors

Question 31

What are examples of illness factors?

Answer 31

Symptoms Severity

Question 32

How can symptoms affect adherence?

Answer 32

Adherence is typically better when patients experience symptoms. This has implications for asymptomatic conditions e.g. T2DM

Question 33

How can severity of illness affect adherence?

Answer 33

With less serious diseases, patients in poorer health are more likely to be adherent. With more serious diseases, patients in poorer health are less likely to be adherent.

Question 34

What are examples of treatment factors?

Answer 34

Preparation Immediate character Administration Consequences

Question 35

What parts of preparation for treatment can affect adherence?

Answer 35

Treatment setting Waiting time Timing of referral

Question 36

What immediate characteristics of treatment can affect adherence?

Answer 36

Complexity of regimen Duration of regimen Degree of behaviour change Expense

Question 37

How can administration affect adherence?

Answer 37

Supervision by HCP (or parents for children), continuity of care

Question 38

What consequences of treatment can affect adherence?

Answer 38

Physical side effects Social side effects Stigma

Question 39

What patient factors can influence adherence?

Answer 39

Patient understanding of: information, the illness and treatment Patient recall of information Health beliefs (health belief model) Beliefs about their illness Beliefs about medication

Question 40

What psychosocial factors influence adherence?

Answer 40

Non-compliant personality Social isolation Social context

Question 41

What healthcare factors lead to non-adherence?

Answer 41

Setting of care Attitudes towards prescriber Doctor-patient interaction

Question 42

Define unintentional non-adherence

Answer 42

Arising from capacity and resource limitations that prevent the patient from following treatment.

Question 43

What can unintentional non-adherence be associated with?

Answer 43

Individual constraints Aspects of the environment

Question 44

Define intentional non-adherence

Answer 44

Arises from the beliefs, attitudes and expectations of the patient. This influences their motivation to persist with treatment.

Question 45

What can interventions to non-adherence address?

Answer 45

Practical barriers Perceptual barriers influencing motivation

Question 46

How effective is intervention to adherence?

Answer 46

Broadly effective Better in interventions that don't focus on a single cause

Question 47

What problems are there with interventions to adherence?

Answer 47

Many lack theoretical input Few are patient centred