adherence to treatment Flashcards
define compliance
Compliance
“the action or fact of applying with a wish or command”
define adherence
Adherence
“attachment or commitment to a person, cause, or belief”
summary of compliance and adherence and concordance
“Compliance refers to the extent to which patients follow doctors’ prescription about medicine taking; adherence refers to the extent to which patients follow through decisions about medicine taking; and concordance refers to the extent to which patients are successfully supported both in decision making partnerships about medicines and in their medicines taking.”
Adherence – World Health Organisation (2003)
Adherence to long-term therapy as “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”
Place strong emphasis on the need to differentiate adherence from compliance.
measuring non-adherence
-direct methods
Direct methods include:
Directly observed therapy
Measurement of level of medicine / metabolite in the blood
Measurement of biologic marker in the blood
measuring non-adherence
-indirect methods
Indirect methods include: Patient questionnaire Patient self-report Pill counts Rates of prescription refills Electronic medication monitors Patient diaries
the scale of non-adherence
In developed countries, the overall average rate of adherence to treatment in long-term conditions is approximately 50% (WHO, 2003)
In Australia, only 43% of patients with asthma take their medication as prescribed all the time, and only 28% use prescribed preventive medication (Reid et al., 2000)
impact and consequences of non-adherence
Poor health outcomes
Increased healthcare costs
Viswanathan et al. (2012) – It is estimated that in the USA, a lack of medication adherence:
Causes nearly 125 000 deaths per year
Causes 10% of all hospital admissions
Costs the healthcare system $100-289 billion per year
Non-adherence - Theories and models
Early theories were based on non-adherence as a result of poor communication and the impact of this on patient understanding and memory.
At this time, interventions were focused on healthcare professional communication, information provision and reminders.
model of intentional and unintentional adherence
draw
non-adherence a current model;
suggest an example
COM-B model of behaviour (Michie et al., 2011) – the performance of a behaviour is caused by the interaction between:
Capability
Opportunity
Motivation
Intended as a starting point for choosing interventions that are most likely to be effective and forms the “hub” of a behaviour change wheel around which are nine intervention functions and seven categories of policy
illness perceptions
Some illness perceptions are associated with treatment adherence in some conditions, e.g.:
Causal beliefs predict adherence behaviour in post MI (Weinman et al., 2000)
Timeline beliefs predict preventer medication adherence in asthma (Horne, Weinman, 2002)
Causal, timeline and control beliefs predict adherence to CBT in psychosis (Freeman et al., 2013)
**However, illness beliefs per se are not the strongest predictors of treatment adherence, and other more proximal factors, i.e. patient beliefs about treatment, need to be considered
what are other factors alongside specific beliefs:
eg:
- specific belief: views about prescribed medication
- necessity: beliefs about necessity of prescribed medication for maintaining health
- concerns: arising from beliefs about potential negative effects
what leads to low adherence (formula)
Doubts about necessity
+
Concerns about potential adverse effects
patient beliefs about illness and treatment….
Influence adherence Have internal logic Are influenced by symptoms May differ from the “medical view” May be based on mistaken beliefs May not be disclosed in the consultation Are not set in stone and can be changed
