Chap 21 (II Adherence)

Question 1

A. Patient characteristics associated with adherence:

What is “Adherence” referring to ?

Answer 1

1. Adherence refers to the extent to which a patient follows the recommendations of the physician:
   Eg: a. taking medications on schedule,
   b. having a needed medical test or surgical procedure c. following directions for changes in lifestyle, eg: diet or exercise.
2. Patients need to recognize that their behavior or condition (e.g., obesity) is problematic before they are motivated to change or seek medical care. The“Stages of Change”model refers to the point at which this recognition and readiness to change occurs.
3. Patients’ unconscious transference reactions to their physicians, which are based in child- hood parent–child relationships, can increase or decrease adherence (see Chapter 6).
4. Only about 1/3 of patients adhere fully to management recommendations, 1/3 adhere some of the time, and 1/3 do not adhere to such recommendations.

Question 2

B. Factors that increase and decrease adherence

Answer 2

1. Adherence is not related to patient intelligence, education, sex, religion, race, socioeconomic status, or marital status.
2. Adherence is most closely related to how well the patient likes the doctor. The strength of the doctor–patient relationship is also the most important actor in whether or not patients sue their doctors when a medical error or omission is made or when there is a poor outcome (see Chapter 23).

Question 3

The Stages of Change Model

How many stages are there and name all

Answer 3

Stg 1: Pre-contemplation (not ready for change)
Stg 2: Contemplation (getting ready)
Stg 3: Preparation (redy for change) 
Stg 4: Action (makes change) 
Stg 5: Maintenance (continues change)  
Stg 6: Relapse (goes back on change)

Question 4

Stg 1: Pre-contemplation (not ready for change)

Answer 4

Fails to recognise that there is a problem

Dr = Elicit the patient’s feelings about the problem and explain the risks of the unwanted behavior.

Question 5

Stg 2: Contemplation (getting ready)

Answer 5

Pt: is ambivalent about making the change

Dr = Weigh the pros and cons of making the change and identify things that may be reducing the likelihood of change.

Question 6

Stg 3: Preparation (redy for change)

Answer 6

Pt: trying small improvement

Dr = Prepare a plan of action for the patient; identify social support systems.

Question 7

Stg 4: Action (makes change)

Answer 7

Pt: makes the needed change

Dr = acknowledge the achievement

Question 8

Stg 5: Maintenance (continues change)

Answer 8

Pt: continues the changed behaviour regardless of familial or social stimulus
Dr = develop strategies to manage temptations and reward success

Question 9

Stg 6: Relapse (goes back on change)

Answer 9

Pt: Feel guilt, anger, and disappointment
Dr = Identify the factors that led
to the relapse, and help the patient to “get back on track.”