Adherence to Treatment Flashcards
what is the definition of compliance?
acting according to a request or a demand.
what is the definition of adherence?
“to stick fast to” e.g. treatment regimen of drugs.
what are the direct measurements of (non)adherence?
o Directly observed therapy.
o Measurements of blood levels of medicine or biological marker.
what are the indirect measurements of (non)adherence?
o Patient self-reporting and patient diaries. o Pill counts. o Rates of prescription refills. o Electronic medication monitors. o Measurement of physiologic markers.
what are some consequences of non-adherence?
o Increased hospital admission (1 in 10 due to non-adherence)
o Rejection of transplants.
o Occurrence of complications.
o Increased mortality
o Poorer health outcomes therefore increased healthcare costs
what are the causes of non-adherence? treatment factors
o Physical aspects - e.g. the packaging of the drugs (easy access). o Complexity. o Duration. o Cost. o Side effects.
what are the causes of non-adherence? presentation factors
o Volume of information. o Order. o Stressing import. o Specificity. o Mode of presentation. o Follow-up.
what are the two types of non-adherence?
intentional and unintentional
what is intentional non-adherence?
know HOW but RELUCTANT – treatment doesn’t make sense, worries or concerns, cultural beliefs about disease.
what is unintentional non-adherence?
doesn’t know HOW – poor HCP-patient communication, low patient satisfaction, cognitive difficulties, financial barriers.
what does the COM-B model describe?
describes factors and interactions relating to adherence.
Capability, motivation and opportunity feeding into adherence.
what are some reasons for non-compliance?
concerns about treatment
beliefs about illness
cost of therapy
necessity of therapy perceived drug efficacy.
what influence health beliefs?
o Identity – what the person identifies the illness as. o Casual beliefs (of drugs). o Timeline (of taking drugs). o Consequences (of taking drugs). o Cure/control (can the drug do this).
COM-B influences non-adherence (as a result of health belief) and health behaviour in general
how can adherence be improved?
1) ask about patient’s adherence
2) consultation to anticipate and plan; identify beliefs and aim to modify them
3) involve significant others; widen the network; use assistive technologies e.g reminders
4) simplify the regime and packaging
5) communication and presentation e.g written information
6) improve understanding of illness and treatment:
- -> provide rationale for necessity
- -> elicit and address CONCERNS with the treatment
- -> agree a practical plan and identify any barriers to such: when and where
what is the “serial position effect”
information said at the beginning and end of the consultation is better recalled than the rest of the information.
what factors affect recall of information?
anxiety, medical knowledge and memory impairment.
what cognitive techniques can be used in improving adherence?
role-play goal-setting stepped behaviour change rewards relapse prevention stress management, desensitisation to stressful stimuli improving self-efficacy.
general improvement points for adherence
- Improve regime
- Identify/modify beliefs.
- Wider network (social support)
- Improve interactions.
- Involve significant others.
- planning and repeating
what sort of information would patients prefer for. recall?
written down
increases adherence
o Flesch formula – based on average sentence length and number of syllables per 100 word
COM-B components
Capacity Opportunity Motivation–> Behaviour
- capacity= ability to engage in health behaviour
- opportunity= all the factors that lie outside the individuals control affecting the execution of behaviour
- motivation = brain processes that energies and direct behaviours
what two factors make up Capacity?
psychological
physical
what two factors make up Opportunity?
physical
social
what two factors make up Motivation?
Belief (reflection)
Habits (automatic)
