Compliance & Adherence Flashcards
What is the definition of adherence?
ADHERENCE = extent to which patient behaviour coincides with medical advice
What is the definition of compliance?
COMPLIANCE = extent to which the patient complies with medical advice
Give some examples of diseases with high rates of adherence/non-adherence.
Adherence: HIV, arthritis, GI disorders, cancer
Non-adherence: pulmonary disease, diabetes, sleep disorders
Give some examples of direct measures of adherence.
- Urine/blood test: expensive, limited to use in clinical practice, invasive, masked non-adherence
- Observation: same as above
Give some examples of indirect measures of adherence.
- Pill counts: more objective than other reports, but still subject to inaccuracies
- Mechanical/electronic dose measure: more objective than other reports, but does not measure whether medication has actually been taken
- Patient self-report: easy and inexpensive, but prone to inaccuracies, bias, and tendency to over-report adherence
- Second-hand report: same as above, but also depends on familiarity with patient
List some factors affecting adherence.
- illness/disease
- treatment
- patient
- belief
- psychosocial
- healthcare
How does illness/disease affect adherence?
- Symptoms (presence of increases adherence)
- Severity (less serious conditions: reduced health INCREASES adherence; more serious conditions: reduced health REDUCES adherence)
How does treatment affect adherence?
- Preparation (treatment setting, waiting time, timing of referral, inconvenience, poor reputation)
- Immediate character (complexity of regimen, duration of regimen, degree of behaviour change, inconvenience, expense, inadequate labels, container design)
- Administration (supervision by health care practitioners & continuity of care)
- Consequences (physical & social side-effects + stigma)
How does the patient affect adherence?
- Understanding (information & content of consultation, treatment regimes)
- Recall (influenced by anxiety, knowledge, importance, the primary/regency effect, no. of statements)
- Beliefs
How does belief affect adherence?
- Illness (severity, symptoms, chronic v.s. episodic)
- Medication (necessity, harmful effects, stigma, conflict with activities, tolerance, masking symptoms, chemical)
Health Belief Model: the more a prescribed medication accords with a patient’s belief system, the more likely they are to adhere
- perceived disease severity
- perceived susceptibility to disease
- benefits of treatment recommended
- barriers to following treatment
How do psychosocial factors affect adherence?
- Cognitive (psychological problems)
- Support (social isolation reduces adherence, social support increases adherence, cohesive families increases adherence)
- Context (e.g. homelessness)
How does healthcare affect adherence?
- Organisational setting (primary v.s. secondary, initial v.s. follow-up, inpatient v.s. outpatient, regular follow-ups, appeal/accessibility of venue, waiting times)
- Prescriber (beliefs & attitudes towards treatment and new prescribes e.g. nurses, pharmacists)
- Doctor-patient interaction (perceived manner, positive behaviours, communication, perceived competence)
Define concordance.
Negotiation between patient & doctor over treatment regimes (nature of interaction, not adherence)
Patient beliefs & priorities respected, patient is active and makes decisions in partnership with doctor
What are the five principles of motivational interviewing?
Express empathy Avoid argument Support self-efficacy Roll with resistance Develop discrepancy
Outline the states of change model/Transtheoretical model.
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
