BSS: Adherence to treatment

Question 1

Explain the concepts of compliance, adherence and concordance.

Answer 1

-The extent to which the patient’s behaviour matches the prescriber’s recommendations”.

-“Adherence presumes an agreement between prescriber and patient about the prescriber’s recommendations. >need for agreement and that the patient is free to decide whether or not to adhere to the doctor’s recommendation.”

-Consultation process in which doctor and patient agree therapeutic decisions that incorporate their respective views, but now includes patient support in medicine taking as well as prescribing communication.

Question 2

Compare the 2 types of doctor-patient relationship.

Answer 2

> Shift from doctor-centred to patient-centred care
* Doctor-centred consultationstyle:
– Paternalistic
– Tightly controlled interviewing style aimed at
reaching an organic diagnosis
* Patient-centredconsultationstyle:
– Less authoritarian – encourages patient to discuss
their own feelings and concerns
– Open questioning, interested in psychosocial
aspects of illness

Question 3

What are the reasons why patients may not adhere?

Answer 3

• Social factors – low levels of education, low levels of social support, young women
• Psychological factors – high anxiety and depression, non- acceptance of illness, use of avoidance coping styles (e.g. denial), perceived stigma of condition (e.g. HIV, epilepsy, mental health problems), negative beliefs about medicines (e.g. distrust and aversion, worries about dependence and addiction)
• Treatment factors – misunderstandings about treatment, complexity of regimen, side effects, poor relationship or communication between doctor and patient, match/mis-match with desired level of control

Question 4

What are the implications of non-adherence?

Answer 4

> People who do not adhere may be putting their health at further risk
* Cost implications
– Amount spent on health education/promotion
– Non-adherence may lead to repeat consultations, waste
of expensive drugs and/or days off work
– A small percentage of people may end up needing more
expensive treatment (e.g. as a hospital in-patient) due to their non-adherence

Question 5

Describe and apply one psychosocial model of adherence.

Answer 5

> adherence is a function of three factors:
– Understanding
* Understanding information given by doctor
– Memory
* Ability to recall the information
– Satisfaction
* Satisfaction with the consultation process