Adherence to treatment

Question 1

Define adherance

Answer 1

“attachment or commitment to a person, cause, or belief” adherence refers to the extent to which patients follow through decisions about medicine taking

Question 2

Define compliance

Answer 2

“the action or fact of applying with a wish or command” “Compliance refers to the extent to which patients follow doctors’ prescription about medicine taking

Question 3

Define concordance

Answer 3

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

Question 4

What type of behaviour does adherence fall into?

Answer 4

Wide spectrum of behaviour rather than a categorical state Can have over or under adherence.

Question 5

Summarise epidemiological shift in disease

Answer 5

Disease burden has moved from acute, infectious disease to chronic lifestyle diseases over the past 50 years. Affects our understanding of adherence.

Question 6

Is there a gold standard for measuring non-adherence?

Answer 6

No Different studies measure it in different ways.

Question 7

What are the direct ways of measuring adherence?

Answer 7

Directly observed therapy Measurement of level of medicine / metabolite in the blood Measurement of biologic marker in the blood

Question 8

What are the indirect methods of measuring adherence?

Answer 8

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

Question 9

What are the consequences of non-adherence?

Answer 9

Poor health outcomes Increased healthcare costs E.g. In USA 2012, lack of medical adherence causes nearly 125,000 deaths a year, 10% of hospital admissions, costs healthcare system 100-289 bill a year.

Question 10

What were early theories of non-adherence based on?

Answer 10

Poor communication and impact this had on patient understanding and memory

Question 11

Summarise the venn diagram of non-adherence?

Answer 11

Unintentional - patient ability+resources lead to practical barriers to adherence Intentional - patient belief+motivation lead to perceptual barriers. There overlap of the two.

Question 12

What is current model on non-adherence?

Answer 12

COM-B model Performance of behaviour caused by interaction of capability, opportunity and motivation Intended as a starting point for choosing interventions.

Question 13

Summarise COM-B model

Answer 13

Question 14

Think about what factors can influence the 3 headings of the COM-B model

Answer 14

Question 15

What are two beliefs that can affect adherence?

Answer 15

Illness perceptions (not the strongest predictor)

Patient’s beliefs about treatment

Question 16

What 2 things influence specific beliefs?

Answer 16

Necessity - necessity of prescribed medication to health

Concerns - Arise from beliefs about potential negative effects

Question 17

What 2 things in combination lead to low adherence?

Answer 17

Doubts about necessity

Concerns about potential adverse effects

Question 18

What can patient beliefs about treatment and illness be influenced by?

Answer 18

Influenced by symptoms

Have internal logic

Mistaken beliefs

May be different beliefs to medical point of view

Patients may not disclose their beliefs

THEY ARE NOT SET IN STONE

Question 19

Summarise the importance of increasing adherence

Answer 19

“increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments”

YOU CAN’T ASSUME ADHERENCE

Question 20

In what ways can adherence be improved?

Answer 20

Interventions: help understand illness and treatment, plan and organise treatment

Consultations: Provide clear rationale for necessity of treatment, elicit + address concerns, agree practical plan for how/where/when to take treatment, indentify barriers

Question 21

Which programme was seen to improve self-reported adherence to asthma preventer medication?

Answer 21

Text message programme designed to modify patients’ illness and treatment beliefs

Patients’ beliefs are amongst factors consistently associated with non-adherence to preventer education.

Question 22

Detail how to the text message program worked

Answer 22

Baseline assessment

Tailored text messages for 18 weeks and normal care

adherence assessment at 6,12,18 wks and 6 months

Question 23

What were findings of text message thing at 18 weeks?

Answer 23

Intervention group had increased relative to control

Perceived necessity for preventer medication

Their belief in the long term nature of their asthma

Perceived contrl over their astma

ALL SIGNIFICANTLY IMPROVED

Question 24

What did a study in stroke survivors show?

Answer 24

Patients’ beliefs should be targetted to improve adherence

Question 25

What are the conclusions that can be drawn from this lecture?

Answer 25

• Non-adherence is common
• Adherence should not be assumed, but discussed with the patient
• Beliefs about illness and treatment are the strongest factors affecting adherence
• Understanding the cause of non-adherence can help identify a suitable intervention
• COM-B model can help to explain non-adherence
• Simple strategies can be used to improve adherence