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.