Adherence to treatment

Question 1

Define adherence and compliance (generic definitions)

Answer 1

Compliance – “the action or fact of applying with a wish or command”

Adherence – “attachment or commitment to a person, cause, or belief”

Question 2

Define adherence, compliance and concordance (concerning health behaviours)

Answer 2

Adherence to long-term therapy is “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” - WHO (2003)

Compliance refers to the extent to which patients follow doctors’ prescription about medicine taking

Concordance refers to the extent to which patients are successfully supported both in decision making partnerships about medicines and in their medicines taking.”

Question 3

How would you describe the scale of adherence?

Answer 3

Adherence is a wide spectrum of behaviour rather than a categorical state (can have differing degrees of under-adherence and over-adherence)

Question 4

In developed countries, the overall average rate of adherence to treatment in long-term conditions is what?

Answer 4

Approximately 50% (WHO, 2003)

Question 5

Give some direct and indirect methods of measuring non-adherence

Answer 5

Note there is no gold standard for measuring non-adherence.

Direct:

• Directly observed therapy
• Measure medicine/biological marker in the blood

Indirect:

• Patient questionnaire
• Patient self-report
• Pill counts
• Rates of prescription refills
• Electronic medication monitors
• Patient diaries

Question 6

State some consequences of non-adherence.

Answer 6

Poor health outcomes
Increased healthcare costs
Increased hospital admissions
Increased mortality

Question 7

What is the COM-B model?

Answer 7

A model of behaviour which hypothesises that interaction between three components – capability, opportunity, and motivation – causes the performance of behaviour and hence can provide an explanation of why a recommended behaviour is not engaged in (i.e. non-adherence)

Question 8

What two factors determine capability? Give some real life examples

Answer 8

Psychological factors, e.g.;

• comprehension of disease and treatment
• cognitive functioning (memory, capacity)
• Executive function (capacity to plan)

Physical factors, e.g.;

• physical capability to adapt to lifestyle changes
• Dexterity

Question 9

What two factors determine opportunity? Give some real life examples

Answer 9

Physical, e.g.;

• cost
• access (availability of meds)
• packaging
• physical characteristics of medicine (taste, smell etc.)
• regimen complexity
• social support
• doctor-patient relationship/communication

Social, e.g.;

• stigma of disease, fear of disclosure
• religious/cultural beliefs

Question 10

What two factors determine motivation? Give some real life examples

Answer 10

Reflective, e.g.;

• perception of illness (cause, chronic vs acute etc.)
• beliefs about treatment
• outcome expectancies
• self-efficacy

Automatic i.e. emotions and impulses arising from associative learning and/or innate dispositions (e.g. depression and anxiety)

Question 11

What might the patient’s beliefs about treatment or prescribed medication be related to?

Answer 11

• Its necessity and efficacy

- Concerns arising from beliefs about potentially negative effects of treatment

Question 12

List strategies to improve adherence

Answer 12

Check the patient’s understanding of treatment, and if necessary:

• Provide a clear rationale for the necessity of treatment
• Elicit and address concerns
• Agree a practical plan for how, where and when to take treatment
• Identify any possible barriers