Adherence to Treatment Flashcards

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1
Q

what is the definition of compliance?

A

acting according to a request or a demand.

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2
Q

what is the definition of adherence?

A

“to stick fast to” e.g. treatment regimen of drugs.

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3
Q

what are the direct measurements of (non)adherence?

A

o Directly observed therapy.

o Measurements of blood levels of medicine or biological marker.

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4
Q

what are the indirect measurements of (non)adherence?

A
o	Patient self-reporting and patient diaries.
o	Pill counts.
o	Rates of prescription refills.
o	Electronic medication monitors.
o	Measurement of physiologic markers.
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5
Q

what are some consequences of non-adherence?

A

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

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6
Q

what are the causes of non-adherence? treatment factors

A
o	Physical aspects -  e.g. the packaging of the drugs (easy access).
o	Complexity.
o	Duration.
o	Cost.
o	Side effects.
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7
Q

what are the causes of non-adherence? presentation factors

A
o	Volume of information.
o	Order.
o	Stressing import.
o	Specificity.
o	Mode of presentation.
o	Follow-up.
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8
Q

what are the two types of non-adherence?

A

intentional and unintentional

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9
Q

what is intentional non-adherence?

A

know HOW but RELUCTANT – treatment doesn’t make sense, worries or concerns, cultural beliefs about disease.

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10
Q

what is unintentional non-adherence?

A

doesn’t know HOW – poor HCP-patient communication, low patient satisfaction, cognitive difficulties, financial barriers.

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11
Q

what does the COM-B model describe?

A

describes factors and interactions relating to adherence.

Capability, motivation and opportunity feeding into adherence.

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12
Q

what are some reasons for non-compliance?

A

concerns about treatment
beliefs about illness
cost of therapy
necessity of therapy perceived drug efficacy.

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13
Q

what influence health beliefs?

A
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

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14
Q

how can adherence be improved?

A

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

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15
Q

what is the “serial position effect”

A

information said at the beginning and end of the consultation is better recalled than the rest of the information.

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16
Q

what factors affect recall of information?

A

anxiety, medical knowledge and memory impairment.

17
Q

what cognitive techniques can be used in improving adherence?

A
role-play
goal-setting
stepped behaviour change
rewards
relapse prevention
stress management, desensitisation to stressful stimuli
improving self-efficacy.
18
Q

general improvement points for adherence

A
  • Improve regime
  • Identify/modify beliefs.
  • Wider network (social support)
  • Improve interactions.
  • Involve significant others.
  • planning and repeating
19
Q

what sort of information would patients prefer for. recall?

A

written down

increases adherence
o Flesch formula – based on average sentence length and number of syllables per 100 word

20
Q

COM-B components

A

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
21
Q

what two factors make up Capacity?

A

psychological

physical

22
Q

what two factors make up Opportunity?

A

physical

social

23
Q

what two factors make up Motivation?

A

Belief (reflection)

Habits (automatic)