Complaince, Adherence And Concordance

Question 0

Define the terms ‘compliance’, ‘adherence’ and ‘concordance’

Answer 0

Compliance - the extent to which the patient complies with medical advice
Adherence - the extent to which patient behaviour coincides with medical advice
Concordance - negotiation between patient and doctor over treatment regimes, patients beliefs and priorities are respected, patient is active, makes decisions in partnership with doctor

Question 1

Describe the key features and techniques of motivational interviewing

Answer 1

Express empathy
Avoid argument
Rolling with resistance 
Encourage self efficacy 
Develop discrepancy

Question 2

Explain the relationship between concordance and adherence

Answer 2

Promotes patient trust and satisfaction with care
Patient involved in decisions about treatment barriers to adherence can be addressed
Patients’ beliefs, expectations, lifestyle, priorities taken into account

Question 3

Describe the extent of non-adherence across patient groups

Answer 3

Common even in severe disease and transplant patients

Impacts patient’s health

Question 4

Describe techniques for measuring adherence, and their strengths and limitations

Answer 4

Direct - urine, blood, observation (most direct measure of consumption, expensive, limited to clinical use, invasive)
Indirect - pill counts, mechanical, patient self report, second hand report (easy to obtain, inexpensive, may be inaccurate, medication may not have been consumed, bias)

Question 5

Describe the factors influencing adherence, and be able to apply these to giving relevant examples of influences on adherence for individual patient cases

Answer 5

Illness/disease - symptoms, severity
Treatment - complexity, duration, convenience
Patient - understanding, beliefs, recall, motivated, benefits/barriers
Psychosocial - social/family support, depression
Healthcare - setting, Dr/patient interaction, concordance

Question 6

Define the terms ‘intentional’ and ‘unintentional non-adherence’, and identify potential reasons for each

Answer 6

Intentional non-adherence - missing/altering doses to suit ones needs e.g. beliefs, attitudes, expectation
Unintentional non-adherence - forgetting/unable to take medication e.g. capacity, memory, environment (problem accessing)

Question 7

Describe the nature of, effectiveness of, and problems with interventions to improve adherence

Answer 7

Approaches - address practical barriers, factors influencing motivation
Effectiveness - broadly but small
Problems - difficult to tell why some interventions work but others don’t, few are patient centred