Building trusting relationships and medication adherence

Question 1

What are some of the ethical principles in the code of ethics?

Answer 1

Beneficence: to do good

• Actions will do good, remove harms and promote welfare

Non-maleficence: ‘at least, do no harm’

• Not taking actions that would inflict harm

Respect for autonomy

• Informed consent

Justice

• Equal treatment of equals, and unequal treatment of unequals

Veracity

• Be truthful to patients

Privacy

• Respect a patient’s wishes to be left alone

Confidentiality

• Not to disclose medical information without patient’s permission

Fidelity

• Keep promises made to the patient

Question 2

Who to report to for mandatory notifications?

Answer 2

Report to AHPRA another practitioner has behaved in a way which presents a serious risk to the public

Question 3

How is shared decision making accomplished? THREE ways.

Answer 3

• Compliance (recommendation)
• Adherence (agreed recommendation)
• Concordance (agreement after negotiation)

shared decision making can improve satisfaction and decisions

Question 4

What is the process of shared decision making?

Answer 4

• Introducing choice (Team talk)
• Describing options, often by integrating the use of patient decision support (Option talk)
• Helping patients explore preferences and make decisions (Decision talk)

Question 5

What are the differences in primary non-adherence and secondary non-adherence

Answer 5

Primary non-adherence

• Failure to purchase a medication

Secondary non-adherence

• Failure to take the medication correctly (at the right dose and at right time)
• Failure to take medication for the prescribed duration (medication non-persistence)

Question 6

What are the FOUR steps in the adherence process?

Answer 6

1. Identify
2. Characterise
3. Strategize
4. Act and follow up

Question 7

Identify adherence through direct and indirect measures? What are the examples of both these types?

Answer 7

Direct: Observation, Dispensing history, Pill Count

Indirect: Patient self-report (survey or patient interview)

Question 8

Adherence is characterized through intentional vs unintentional. What does this mean?

Answer 8

Intentional (conscious date)

• Beliefs about condition
• Beliefs about treatment

> Motivations

> Preferences

PERCEPTUAL BARRIERS

Unintentional (practical issues and barriers)

• Limited medication availability

Question 9

Adherence is strategized through

A) necessity vs concern

B) theory of planned behaviour

C) state of change of patient

Explain the terms explained above

Answer 9

A)

Patients weigh up their perceived need for the treatment against their concerns of the treatment

Higher necessity than concern beliefs = good adherence

B and C)

See attached image

Question 10

Adherence includes acting and follow up.

A) What are the factors this involves

B) What is the objective

C) why follow up?

Answer 10

A)

Patient factors

• Perceptions, Beliefs and Motivations
• Co-morbid conditions, personal characteristics and circumstances

Treatment factors

• Frequency
• Duration
• Complexity
• Cost

Ecological factors

• HCP communication / relationship
• Social support

B)

Objective: Use data collected from the use of tools and models from previous steps to determine a shared objective –> motivational interviewing

Decide on appropriate intervention and document

> device

> services

C)

• Check outcome
• Review intervention