HealthPsych Session 8 Flashcards
What is adherence?
Extent to which pt behaviour coincides with medical advice
Is non-adherence the norm, even in conditions where it could prove fatal?
Yes
What are the outcomes of non-adherence?
Impact on pt’s health
Financial implications of wasted drugs, consultations etc
What percentage of pts with chronic illnesses are non-adherent?
50%
In what type of treatment regime are low adherence rates typically seen?
Those that include lifestyle changes
Which diseases have the highest rates of adherence?
HIV
Arthritis
GI disorders
Cancers
Which diseases have the highest rates of non-adherence?
Pulmonary disease
Diabetes
Sleep disorders
Which could have a greater impact on improving population health: improving adherence or improvement in specific medical Tx?
Improving adherence
What are the problems with measuring adherence?
Definition of adherence - do you have to take prescription exactly as prescribed for it to be effective?
Tx over a period of time so when best to assess?
Lack of consistency in measures
Difficulty of comparison of studies between different conditions with different Tx
What direct measures can be used to measure adherence?
Urine/blood test
Observation
What are the problems associated with using urine/blood tests to measure adherence?
Expensive
Limited to clinical practice
Metabolism
Non-adherence masked by adherence just prior to test
Delay in lab reports delays interventions until after point of care
What indirect measures can be used to measure adherence?
Pill counts Mechanical/electronic measures of dose Pharmacy records Pt self-report 2nd-hand reports Attendance rates for lifestyle Tx
What pt factors can influence adherence?
Understanding of information, illness and Tx
Recall of Tx and regime
Health belief model
What illness/disease factors impact adherence?
Adherence increases when pts experience symptoms
Severity of disease: pts in objectively poorer health with less serious disease more likely to be adherent, pts in objectively poorer health with more serious diseases less likely to adhere
What treatment factors can affect adherence?
Preparation - Tx setting, waiting time etc
Immediate character - complexity of regimen, duratio, degree of behaviour change
Administration
Consequences - physical/social S/E
What psychosocial factors can affect adherence?
Psychological health
Social support
Social context
Has a ‘non-compliant’ personality been identified?
No, seen in all types of pts
What healthcare factors can impact adherence?
Organisational setting
Prescriber beliefs and attitudes towards Tx
Dr-pt interaction
What is unintentional non-adherence?
Capacity and resource limitations prevent pt from following Tx regardless of motivation
What does intentional non-adherence arise from?
Beliefs, attitudes and expectations that influence pt motivation
What is compliance?
Extent to which pt complies with medical advice
What does concordance refer to?
Nature of the interaction b/w clinician and pt when negotiating Tx regimes
Why is better adherence associated with concordance?
Beliefs and barriers addressed and trust built up
What different focuses of address are needed in unintentional non-adherence compared to intentional?
Practical barriers in unintentional
Perceptual factors in intentional
