Adherence to Treatment

Question 1

Definition of non adherence

Answer 1

Patient’s behaviour doesn’t match agreed recommendations made by prescriber

Question 2

What 5 actions would be considered non adherent behaviour

Answer 2

Overuse of meds
Not collecting meds
Missed/changed doses
Non persistence
Not attending appointments

Question 3

Describe the prevalence of non adherence

-when is non adherence the highest and the lowest

Answer 3

30-50% of drugs not taken as directed

Highest for preventative/lifestyle behaviours

Lowest for serious illnesses

Question 4

What are the effects of non adherence

• disease
• personal costs
• societal costs

Answer 4

Disease progression/delayed recovery/increased morbidity and complications

Personal costs

• increased disability
• decreased QOL

Societal costs

• increased healthcare costs
• more aggressive treatment may be needed

Question 5

What are the 2 types of non adherence

Answer 5

Unintentional

Intentional

Question 6

What actions would fit under unintentional non adherence

Answer 6

• lacks capacity to remember
• functional limitations (practical barriers)
• resource limitations
• lacks understanding on when to take meds/treatment

Question 7

What actions would fit under intentional non adherence

Answer 7

• asymptomatic (inaccurate illness perception)
• lack of motivation due to
• relationship with HCS
• lack of social support
• negative emotions

-treatment perceptions

Question 8

What are the 2 types of perception that could affect chances of adherence

Answer 8

Illness perception

• identity
• cause
• timeline
• cure/control
• consequence

Treatment perception

• necessity
• concerns

Question 9

What 3 factors dictate chances of adherence

Answer 9

Illness perception
Symptoms
Negative views about drugs

Balance between necessity and concerns

Question 10

How do illness beliefs affect adherence

• consequence
• timeline
• personal control
• emotional effects

Answer 10

Increased consequence perception
Increased timeline perception
Lead to increased adherence

Personal control can lead to either

• increased capability to take meds => adherence
• negate needs to take meds => non adherence

Emotions

• +ve => adherence
• -ve =>adherence

Question 11

How do treatment beliefs affect adherence

• necessity
• concerns

Which type of perception is more influential in adherence

Answer 11

Increased necessity => adherence
Increased concern => non adherence

Stronger predictors of adherence than illness perceptions
Illness perceptions impact on treatment perceptions

Question 12

How would you increased adherence

Answer 12

Use motivational interviewing to maintain a good quality relationship with the patient

Address concerns and current illness and treatment perceptions => high neccessity and low concerns

Question 13

How would you reduce the risk of non intentional non adherence

Answer 13

Remove barriers

• repeat prescriptions
• financial, social

Communicate well so the patient remembers and understands

Question 14

How would you reduce the risk of intentional non adherence

Answer 14

Identify maladaptive illness and treatment perceptions and address them
-concerns, symptoms and consequences

Communicate well so the patient understands and remembers

Question 15

How would you tailor intervention to the perceptions

Answer 15

Targeted texting based on individual profiles

• increased perceived necessity, control duration of LTCV
• behaviour and belief changes sustained

Anticipate and normalise non adherence
Discuss collaboratively