Engagement & concordance Flashcards
What is the reason for different terminology used when talking about patient engagement?
It is used within different medical professions, changes in the language can enable a more patient centred approach
However, use of multiple terminology makes it difficult to compare study findings & may restrict research progress.
Define compliance
‘the extent to which a persons behaviour coincides with medical advice given e.g., if they are sticking to a diet’, it suggests that HP’s take the lead role and instruct patients on what to do
It suggests how we expect obedience from patients
Define adherence
‘the extent to which a persons behaviour is corresponding to the agreed recommendations from the HP, e.g., diet & exercise’, this involves patients taking an active role in their care
Define concordance
‘the process of developing a mutually agreed treatment plan’, shows a partnership between patient and HP, indicates shared decision of what is best, creating a therapeutic alliance
Why don’t patients listen to the doctor’s instructions
We are in denial about our health
We feel hopeless about treatment
We don’t want to change our lifestyle
The condition doesn’t feel real to us or worry us
Define adherence failure
Adherence failure: refers to the situation in which a patient does not follow the prescribed treatment plan or medical recommendations
Examples: failure to take medication as instructed, missing medical appointments, skipping rehab & not following lifestyle advice
What are the impacts of adherence failure?
Rates range from 10-85%
Overall 40% failure rate to adhere
Adherence is lower for those patients who are on long-term pharmacotherapy
What are the consequences of adherence failure?
Economic: waste of medical resources (meds, appointments etc), costly treatment side effects due to post-op complications or reoccurrence of symptoms, repeated doctor or specialist visits.
Clinical: majority of healthcare treatments will not work without patient adherence, adherence is associated with positive outcomes in health & improved survival, many diseases can only be prevented/treated if treatment plans & protocols are followed correctly
What are the possible reasons for adherence failure?
Forgetfulness: Patients may simply forget to take medications or attend appointments.
Lack of understanding: Patients might not fully understand the importance of their treatment plan or how to follow it correctly.
Side effects: Unwanted side effects of medication or treatment may discourage a patient from adhering to the plan.
Cost or accessibility: Financial constraints or difficulty accessing care can prevent patients from following through.
Psychological factors: Mental health issues such as depression or anxiety can interfere with adherence.
Lack of trust in treatment process and in healthcare providers
Patients have analysed the pros & cons of the effect of treatment, side effects, lifestyle changes etc
Describe the reasons for adherence for the COVID vaccine
14% refused to take vaccine as they had distrust in the pharmaceutical companies, preferred natural immunity & were worried about potential side effects.
Those groups with high distrust levels were:
- females
- minority groups
- low annual income
- low levels of education
- poor knowledge of COVID
What are the barriers to adherence?
Low levels of physical activity
Low self-efficacy
Depression & anxiety, Conditions like depression, anxiety, or cognitive impairments can reduce motivation or ability to adhere.
Poor social support, Without family, friends, or caregivers to encourage and help, patients may struggle to adhere.
Greater barriers to exercise, Physical limitations due to illness or aging can prevent patients from managing their treatment regimen effectively.
Increased pain during exercise
What are the predictors of a patient with greater adherence
- Being in greater physical shape, more likely to carry out rehab exercises
- Self-efficacy, Patients who feel confident in their ability to manage their health are more likely to adhere.
- Younger patients, maybe more adaptable than older patients, but may have less discipline
- Social support, those with family, friends & others can be encouraged and have greater adherence
- Convenience, how easy the treatment is to implement in daily routine makes it more likely for a patient to follow
What factors can influence adherence
- Social factors e.g., education, literacy, employment & social support
- Psychological factors: MH conditions e.g., depression, denial & routine interruption
- Treatment factors: having bad side effects, misunderstanding the treatment plan, poor relationship between patient and HP, little obvious benefit from treatment
How can we measure adherence?
Through direct & indirect methods
How can we measure adherence directly?
Through tests e.g., blood tests, pill counts & electronic measurement devices
DISADV: not always accurate, pills can be thrown away or lost, expensive & intrusive, not always practical
How can we measure adherence indirectly?
By directly asking the patient e.g., self-report,
We can ask their significant others or family members for information
ADV: cost-effective, quick, easy
DISADV: responses may be biased and inaccurate recall
How can we promote encouragement to adhere?
- Having a good relationship between the patient and the HP
- Having good communication between the patient and the HP
- Educating the patient and providing resources
- Identify & address possible barriers for the patient
- Recognize that each patient experience is unique
- work with the patient, their family & any other HP’s involved in their treatment
Describe how to use open questions
Ask how and what, listen more than you talk, encourage the patient to think through their own thoughts and possible solutions. Make suggestions if necessary and by phrasing them using ‘how’ or ‘what’
Do not use why as it appears judgmental & place blame.
Telling people what to do doesn’t really work so helping them work through their own solutions is important to develop concordance
How does using open questions influence adherence?
By using open questions they are framed in a non-threatening way in which no blame or judgement is passed to the patient. It allows us to better understand the patient & why they may adhere from treatment. There may be an alternative reason for non-adherence then blame/lazinesss
