Health - 4 Flashcards
What was the range of non-adherence found by Donovan and Blake 1992
15-93%
What does adherence tend to be higher in
In individuals experiencing more severe illness items
What is the problem with measuring non adherence as a self report
Would a patient actually admit non adherence ?
What is the problem with measuring non adherence with therapeutic outcome
Even non adherents will get better
What is the problem with measuring non adherence with health worker estimates
Drs incorrectly predicted adherence 41% of the time (Patterson et al 2000)
What is the problem with measuring non adherence with pill counts
Just beachside pull is gone does not mean it is consumed
What is the problem with measuring non adherence with electronic methods
The data recorders in pull bottles are expensive and should be reliable, but patient can remove pull and not consume
What is the problem with measuring non adherence biochemical tests
The blood and urine tests are time consuming and expensive and there are lots of confounds
What are the 3 types of non adherence identified by Donovan and Blake
Rational - deliberately non-adherent
Unwitting - not your fault, a misunderstanding
Erratic - forgetful or you run out
What is non-adherence
The process in which the patient actively decides not to use treatment or follow treatment recommendations
What did sarafino et al find was a reason we rationally decide not to adhere
Side effects - unpleasant or undesirable side effects
Believe treatment is not working
Practical barriers - cost
What is the reason vlasnik found as to why we decide not to adhere
Multiple physicians - decrease patients confidence in prescribed treatment
What reason did apter et al 2003 find was a reason we deceive not to adhere
Fear of dependence - fears of addictive behaviour and adverse side effects
What reason did lim and ngah find was a reason to decide not to adhere
Religious beliefs - may have a preference for natural remedies
Why may a reason Eaton give the pharmaceutical company as a reason for non adherence
As they do not want that pharmaceutical company to make any profit or benefit in any way
What is a non deliberate reason for adherence
Memory - the patient may not be able to recall what they have been told
What did ley et al find in 1979 when asking patients to recall a series of statements presented in two ways
Recall was 25% better for structured info, also better for info presented at beginning of consultation
What did Sokol et al 2005 find with the relationship between adherence and risk for hospitalisation in diabetes patients
More non-adherence related to greater overall cost
Describe the study of Searle et al in 2008 with diabetic patients and foot ulcers
Qualitative approach- interviews asking patients why they did not adhere
15% of all diabetics develop Foot ulcers and can months or years to heal and 1/5 undergo amputation
The treatment it is elevated foot, antiobiotics and simple wound care
Why in searles study did patients not adhere to wearing the footwear
Uncomfortable
Difficulty walking
Why in Searles study did patients not adhere to foot rest
Patients doing foot rest boring, frustration and impractical
