Adherence To Treatment Flashcards
Define compliance.
Compliance is the extent to which the patient complies with medical advice.
Define adherence.
The extent to which patient behaviour coincides with medical advice.
What is the difference between compliance and adherence?
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)
Define concordance.
Negotiation between the patient and doctor over treatment regimes.
What does concordance imply?
That the patient is active and in partnership with the doctor
What does concordance allow for?
The patient’s beliefs and priorities to be respected and for decisions to be shared
How may concordance lead to adherence?
- 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.
What is the norm in terms of adherence to medical advice?
Non-adherence is the norm
What percentage of chronically ill patients do NOT adhere to medical advice?
50%
What percentage of hospitals admissions of chronically ill patients are due to non-adherence?
10-25%
What is the percentage of non-adherence to medication?
~21%
What is the percentage of non-adherence to exercise?
~28%
What is the percentage of non-adherence to diet?
~42%
Which diseases have the highest rates of adherence?
HIV, arthritis, GI disorders, and cancer
Which diseases have the highest rates of non-adherence?
Pulmonary disease, diabetes, and sleep disorders
Give two examples of direct measures of adherence
Urine or blood test
Observation (e.g. Of consumption)
What are the advantages of urine or blood tests?
Provides a direct measure of consumption/adherence
What are the disadvantages of urine or blood tests?
Expensive
Limited to use in clinical practice
Invasive
What are the advantages of direct observation of adherence?
Provides a direct measure of consumption/adherence
What are the disadvantages of direct observation of adherence?
Expensive
Limited to use in clinical practice
Invasive
Give four examples of indirect measures of adherence
Pill counts
Mechanical or electrical measures of dose dispensing
Patient self-report
Second-hand reports
What is the advantage of pill counts?
More objective than self / other-reports
What is the disadvantage of pill counts?
Still subject to inaccuracy (e.g. Lost pills)
What are the advantages of mechanical or electrical measures of dose dispensing?
Objectively measures whether a dose has been dispensed
More accurate than other indirect measures
What is the disadvantage of mechanical or electrical measures of dose dispensing?
Doesn’t measure if the dispensed medication was actually taken
What are the advantages of patient self-report?
Easy to obtain
Inexpensive
What are the disadvantages of patient self-reports?
Prone to inaccuracies/bias
Tendency to over-report adherence
What are the advantages of second-hand reports?
Similar to self-reports
What are the disadvantages of second-hand reports?
Similar to self-reports
Also depends on familiarity with patient
What are the main contributing factors for non-adherence?
Illness factors
Treatment factors
Patient factors
Psychosocial factors
Healthcare factors
What are examples of illness factors?
Symptoms
Severity
How can symptoms affect adherence?
Adherence is typically better when patients experience symptoms.
This has implications for asymptomatic conditions e.g. T2DM
How can severity of illness affect adherence?
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.
What are examples of treatment factors?
Preparation
Immediate character
Administration
Consequences
What parts of preparation for treatment can affect adherence?
Treatment setting
Waiting time
Timing of referral
What immediate characteristics of treatment can affect adherence?
Complexity of regimen
Duration of regimen
Degree of behaviour change
Expense
How can administration affect adherence?
Supervision by HCP (or parents for children), continuity of care
What consequences of treatment can affect adherence?
Physical side effects
Social side effects
Stigma
What patient factors can influence adherence?
Patient understanding of: information, the illness and treatment
Patient recall of information
Health beliefs (health belief model)
Beliefs about their illness
Beliefs about medication
What psychosocial factors influence adherence?
Non-compliant personality
Social isolation
Social context
What healthcare factors lead to non-adherence?
Setting of care
Attitudes towards prescriber
Doctor-patient interaction
Define unintentional non-adherence
Arising from capacity and resource limitations that prevent the patient from following treatment.
What can unintentional non-adherence be associated with?
Individual constraints
Aspects of the environment
Define intentional non-adherence
Arises from the beliefs, attitudes and expectations of the patient. This influences their motivation to persist with treatment.
What can interventions to non-adherence address?
Practical barriers
Perceptual barriers influencing motivation
How effective is intervention to adherence?
Broadly effective
Better in interventions that don’t focus on a single cause
What problems are there with interventions to adherence?
Many lack theoretical input
Few are patient centred
