Engagement and concordance Flashcards
Define compliance
The extent to which a persons behaviours concides with medical or health advice (Haynes. Taylor and sackett, 1979)
-passive behaviours
-blame for non-compliance lies with the patient
-patients are expected to comply with instructions (morrison and bennett 2009)
-expectation of obedience
-healthcare profesionals take the lead
Define adherance
the extent to which a persons behaviour corrosponds with an agreed reccomendation from healthcare provider (WHO,2003)
-non judgemental
-patients are involved in the decision making process
-patients assume a more active and informed role
Define concordance
the process of developing a mutually agreed treatment plan- snowden and marland 2012
-partnership and agreement between patient and healthcare professional
-shared decision making not one directional delivery
-closley linked to the terms therapeutic alliance or co-creation
How widespread is adherance?
-range from 10-85% (kyngas et al, 20000
-overall 40% fail to adhere
-adherance lowered for patients on long term pharmacotherapy
What are some economic consequences of non compliance, adherance, concordance?
-waste of medical resources, (not taking medication, using equiptment or aids or attending appointments)
-costly treatment side effects (post opperative complications, reoccurance of symptoms)
-repeated doctor and specialist visists
What are some clinical complications of non adherance, concordance or compliance?
-majority of health care regimens will not work if the patient chooses not to adhere
-adherance is associated with positive health outcomes and improved survival
-many diseases and illnesses are only preventable or treatable if specific treatment protocols are followed
Describe intentional vs non intentional adherance
-increased understanding that non adherance may be the ressult of rational descion being influenced by a cost benefit analysis
-cons- side effects, disruption to lifestyle, financial cost, lack of trust in treatment
pros-improvement in symptoms, long term relief
What are some barriers to adherance?
-jack et al, 2010- symptomatic review of barriers within the context of musculoskeletal physiotherapy
-low levels of physical activity
-low self efficacy
-depresion and anxiety
-helplessness
-poor social support
-greater percieved barriers to excersise
-increased pain during excersise
name some predictors of greater adherance
-better physical health
-less fear of failing
-younger
What factors affect adherance behaviours?
social- education, unemployment, low social support
psychological- high anixety, depression, coping style, interuption to daily routine
treatment-misunderstandings. complexity, side effects, poor heealth profesional relationship
What are some direct and indirect measures for assessing adherance?
direct-
-biomediccal(blood/urine analysis)
-pill counting dispense
-electronic measures
-indirect-
-directly asking the patient
-seeking information from significant others
What are some problems with direct measures to assess adherance?
-not always accurate
-pills can be thrown away
-expensive and intuitive
-not always practical within a clinical setting
What are some problems and advantages of indirect measures to assess adherance?
adv- cost effective, ease and speed in completion
probelms- response bias, inaccurate recall
describe patient centred approach to adherance
-patients view and reasons for non adherance provides a valuable perspective
-non adherance is likely multifacted
-normalising non adherance and framing questions in a non threatening way can minimise social desirable response
-blame free explanations
-important patients can see other people can be in a similar situation
How can we promote engagement?
-good communication
-education
-share rescources
-provide easily acessible assistance
-identify and address barriers
-recognise all patients and their experiences are unique
-work in partnership with the patient, family, other health proffesional
