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ESA 3 - HPHD > Adherence To Treatment > Flashcards

Adherence To Treatment Flashcards

1
Q

Define compliance.

A

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

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2
Q

Define adherence.

A

The extent to which patient behaviour coincides with medical advice.

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3
Q

What is the difference between compliance and adherence?

A

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)

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4
Q

Define concordance.

A

Negotiation between the patient and doctor over treatment regimes.

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5
Q

What does concordance imply?

A

That the patient is active and in partnership with the doctor

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6
Q

What does concordance allow for?

A

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

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7
Q

How may concordance lead to adherence?

A
  • 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.
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8
Q

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

A

Non-adherence is the norm

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9
Q

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

A

50%

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10
Q

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

A

10-25%

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11
Q

What is the percentage of non-adherence to medication?

A

~21%

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12
Q

What is the percentage of non-adherence to exercise?

A

~28%

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13
Q

What is the percentage of non-adherence to diet?

A

~42%

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14
Q

Which diseases have the highest rates of adherence?

A

HIV, arthritis, GI disorders, and cancer

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15
Q

Which diseases have the highest rates of non-adherence?

A

Pulmonary disease, diabetes, and sleep disorders

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16
Q

Give two examples of direct measures of adherence

A

Urine or blood test

Observation (e.g. Of consumption)

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17
Q

What are the advantages of urine or blood tests?

A

Provides a direct measure of consumption/adherence

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18
Q

What are the disadvantages of urine or blood tests?

A

Expensive

Limited to use in clinical practice

Invasive

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19
Q

What are the advantages of direct observation of adherence?

A

Provides a direct measure of consumption/adherence

20
Q

What are the disadvantages of direct observation of adherence?

A

Expensive

Limited to use in clinical practice

Invasive

21
Q

Give four examples of indirect measures of adherence

A

Pill counts

Mechanical or electrical measures of dose dispensing

Patient self-report

Second-hand reports

22
Q

What is the advantage of pill counts?

A

More objective than self / other-reports

23
Q

What is the disadvantage of pill counts?

A

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

24
Q

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

A

Objectively measures whether a dose has been dispensed

More accurate than other indirect measures

25
Q

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

A

Doesn’t measure if the dispensed medication was actually taken

26
Q

What are the advantages of patient self-report?

A

Easy to obtain

Inexpensive

27
Q

What are the disadvantages of patient self-reports?

A

Prone to inaccuracies/bias

Tendency to over-report adherence

28
Q

What are the advantages of second-hand reports?

A

Similar to self-reports

29
Q

What are the disadvantages of second-hand reports?

A

Similar to self-reports

Also depends on familiarity with patient

30
Q

What are the main contributing factors for non-adherence?

A

Illness factors

Treatment factors

Patient factors

Psychosocial factors

Healthcare factors

31
Q

What are examples of illness factors?

A

Symptoms

Severity

32
Q

How can symptoms affect adherence?

A

Adherence is typically better when patients experience symptoms.

This has implications for asymptomatic conditions e.g. T2DM

33
Q

How can severity of illness affect adherence?

A

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.

34
Q

What are examples of treatment factors?

A

Preparation

Immediate character

Administration

Consequences

35
Q

What parts of preparation for treatment can affect adherence?

A

Treatment setting

Waiting time

Timing of referral

36
Q

What immediate characteristics of treatment can affect adherence?

A

Complexity of regimen

Duration of regimen

Degree of behaviour change

Expense

37
Q

How can administration affect adherence?

A

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

38
Q

What consequences of treatment can affect adherence?

A

Physical side effects

Social side effects

Stigma

39
Q

What patient factors can influence adherence?

A

Patient understanding of: information, the illness and treatment

Patient recall of information

Health beliefs (health belief model)

Beliefs about their illness

Beliefs about medication

40
Q

What psychosocial factors influence adherence?

A

Non-compliant personality

Social isolation

Social context

41
Q

What healthcare factors lead to non-adherence?

A

Setting of care

Attitudes towards prescriber

Doctor-patient interaction

42
Q

Define unintentional non-adherence

A

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

43
Q

What can unintentional non-adherence be associated with?

A

Individual constraints

Aspects of the environment

44
Q

Define intentional non-adherence

A

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

45
Q

What can interventions to non-adherence address?

A

Practical barriers

Perceptual barriers influencing motivation

46
Q

How effective is intervention to adherence?

A

Broadly effective

Better in interventions that don’t focus on a single cause

47
Q

What problems are there with interventions to adherence?

A

Many lack theoretical input

Few are patient centred

ESA 3 - HPHD (15 decks)

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