HPHD Adherence

Question 1

Define:
Compliance
Adherence
Concordance

Answer 1

Compliance is the extend to which a patients complies with medical advice. An old phrase as it implies that the doctor has all power and patient is passive

Adherence is the extent to which a patient behaviour coincides with medical advice. Used currently because it is more patient centred and highlights the patients right to choose

Concordance is the nature of the interaction between the patient and clinician - the negotiation over treatment regimes where patient is active in making decisions

Question 2

How common is non-adherence?

Answer 2

50% of pts with chronic illness are non adherent to their treatment
10-25% of hospital admissions are due to non adherence
22% of renal transplant patients are non adherent with their immunosuppressants (and therefore 91% experience organ rejection or death)

Question 3

What are some of the problems in measuring non adherence?

Answer 3

What actually counts as non adherence? eg if a patient takes their tablets at incorrect intervals is that non adherence

Treatment can be long term therefore people can switch between adherent and non adherent

Hard to make direct comparisons for different conditions with different treatments

Question 4

How can adherence be measured?

Answer 4

Direct measures:
- urine or blood test
- observation of consuming medicines
(expensive, can be masked eg taking medicine just before blood test)

Indirect measures:
- pill counts
- recording what time pill container has been opened
(doesnt actually mean medicine has been taken)
- self reports (bias, inaccurate)

Question 5

Why dont patients adhere to medical advice or treatment?

Answer 5

• adherence is poorer when patients are asymptomatic eg hypertension
• in minor illnesses those in poor health are more likely to adhere, whereas in major illnesses those with poorer health less likely to adhere
• social side effects
• physical side effects
• lack of understanding and recall
• depressed 3x less likely to adhere
• social support = higher adherence
• communication with doctor

Question 6

What is unintentional non adherence?

Answer 6

Capacity and resource limitations that prevent patients from following treatment eg problems accessing / affording prescriptions

Question 7

What is intentional non adherence?

Answer 7

Arises from beliefs and attitudes that influence the patients to non adhere

Question 8

What are some interventions that can be used to improve adherence?

Answer 8

• address barriers to adherence such as lack of resources
• addressing the factors influencing patients decisions to not adhere

(a combination of the 2 is most effective)

Question 9

What is the relationship between concordance and adherence?

Answer 9

Achieving concordance leads to better adherence because the patient has actively participated to make decision about the treatment. The patients lifestyle and priorities have been taken into account and it promotes trust and satisfaction with care.