Adherence to treatment Flashcards
Define adherance
“attachment or commitment to a person, cause, or belief” adherence refers to the extent to which patients follow through decisions about medicine taking
Define compliance
“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
Define concordance
concordance refers to the extent to which patients are successfully supported both in decision making partnerships about medicines and in their medicines taking.”
What type of behaviour does adherence fall into?
Wide spectrum of behaviour rather than a categorical state Can have over or under adherence.
Summarise epidemiological shift in disease
Disease burden has moved from acute, infectious disease to chronic lifestyle diseases over the past 50 years. Affects our understanding of adherence.
Is there a gold standard for measuring non-adherence?
No Different studies measure it in different ways.
What are the direct ways of measuring adherence?
Directly observed therapy Measurement of level of medicine / metabolite in the blood Measurement of biologic marker in the blood
What are the indirect methods of measuring adherence?
Patient questionnaire Patient self-report Pill counts Rates of prescription refills Electronic medication monitors Patient diaries
What are the consequences of non-adherence?
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.
What were early theories of non-adherence based on?
Poor communication and impact this had on patient understanding and memory
Summarise the venn diagram of non-adherence?
Unintentional - patient ability+resources lead to practical barriers to adherence Intentional - patient belief+motivation lead to perceptual barriers. There overlap of the two.
What is current model on non-adherence?
COM-B model Performance of behaviour caused by interaction of capability, opportunity and motivation Intended as a starting point for choosing interventions.
Summarise COM-B model
Think about what factors can influence the 3 headings of the COM-B model
What are two beliefs that can affect adherence?
Illness perceptions (not the strongest predictor)
Patient’s beliefs about treatment
What 2 things influence specific beliefs?
Necessity - necessity of prescribed medication to health
Concerns - Arise from beliefs about potential negative effects
What 2 things in combination lead to low adherence?
Doubts about necessity
Concerns about potential adverse effects
What can patient beliefs about treatment and illness be influenced by?
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
Summarise the importance of increasing adherence
“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
In what ways can adherence be improved?
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
Which programme was seen to improve self-reported adherence to asthma preventer medication?
Text message programme designed to modify patients’ illness and treatment beliefs
Patients’ beliefs are amongst factors consistently associated with non-adherence to preventer education.
Detail how to the text message program worked
Baseline assessment
Tailored text messages for 18 weeks and normal care
adherence assessment at 6,12,18 wks and 6 months
What were findings of text message thing at 18 weeks?
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
What did a study in stroke survivors show?
Patients’ beliefs should be targetted to improve adherence
What are the conclusions that can be drawn from this lecture?
- 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
