Lecture 6.1: Adherence to Treatment

Question 1

What percentage of patients with chronic illnesses don’t take their medication properly?

Answer 1

50 to 60% of patients with chronic illnesses miss doses, take the wrong doses, or drop off treatment in the first year

Question 2

What is Compliance?

Answer 2

• Extent to which patient conforms or fulfills
medical advice
• Doing what they are told
• Dr. knows best (powerful dr., passive patient)

Question 3

What is Adherance?

Answer 3

• Extent to which patient behaviour coincides
with medical advice
• Patient-centered, agreement, right to choose,
‘active’ engagement

Question 4

What is Concordance?

Answer 4

• Doctor-patient negotiation
• Respects patient beliefs and priorities

Question 5

Why is Concordance important? (3)

Answer 5

• Shared ownership/decision-making
• Barriers to adherence addressed
• Promotes patient trust and satisfaction

Question 6

Types of Non‐Adherers (5)

Answer 6

1) Consistent Underdoser
2) Consistent Overdoser
3) Random Doser
4) Abrupt Overdoser
5) Tourist (takes “drug holidays”)

Question 7

Types of Non‐Adherers: Consistent Underdoser

Answer 7

• Regularly neglects to take one of the
prescribed doses
• Such as the midday dose
• Regularly takes only some of the prescribed
medications

Question 8

Types of Non‐Adherers: Consistent Overdoser

Answer 8

• Regularly takes a drug more often or in larger doses than is prescribed

Question 9

Types of Non‐Adherers: Random Doser

Answer 9

• Takes the medications when she or he thinks of it

Question 10

Types of Non‐Adherers: Abrupt Overdoser

Answer 10

• Does not take medications properly and then takes an overdose prior to a
clinic visit
• Doubles up for missed doses

Question 11

Types of Non‐Adherers: Tourist (takes “Drug Holidays”)

Answer 11

• Abruptly stops all medications for a few days or weeks
• Takes one day off per week

Question 12

How many more lives could be saved if patients adhered to treatment?

Answer 12

• An estimated 125,000 lives could be saved annually with better medication
compliance

Question 13

What is the greatest cause of re‐admissions to hospitals?

Answer 13

Non-Adherence

Question 14

Direct Measures to Observe Adherence (3)

Answer 14

• Urine Test
• Blood Test
• Observation of Consumption

Question 15

Indirect Measures to Observe Adherence (4)

Answer 15

• Electronic Measures
• Pill Counts
• Repeat Prescription/Pharmacy Records
• Patient Self-Report

Question 16

Problems with Patient Self-Reporting (4)

Answer 16

• Inaccuracies/Bias
• Tendency to over-report adherence (often 10‐20% higher)
• Second-hand reports
• Depends on familiarity with patient

Question 17

Problems with Repeat Prescription/Pharmacy Record (2)

Answer 17

• Subject to inaccuracy (lost pills)
• Do not measure when/if medication taken correctly

Question 18

What comes under “Unintentional Non-Adherence”? (4)

Answer 18

• Lack of understanding of instructions
• Forgetting instructions/doses
• Difficulty following prescribed regimen
• Problems accessing treatment

Question 19

What comes under “Intentional Non-Adherence”? (2)

Answer 19

• Reasoned decision
• Beliefs, attitudes, expectations

Question 20

Factors believed to affect Compliance: Patient Barriers (6)

Answer 20

• Patient knowledge
• Prior compliance behaviour
• Ability to integrate into daily life
• Complexity of the particular drug regimen
• Health beliefs and perceptions of possible benefits of treatment (self efficiency)
• Social support (including practitioner relationships)

Question 21

Factors believed to affect Compliance: Health Beliefs (3)

Answer 21

• How serious is my disease
• What are the sequences of being careless in treating the disease
• Self Efficiency

Question 22

What is Capability?

Answer 22

• Capability is defined as the individual’s psychological and physical capacity to
engage in the activity concerned
• It includes having the necessary knowledge and skills.

Question 23

What is Motivation?

Answer 23

Brain processes that energise and direct behaviour

Question 24

What is Opportunity?

Answer 24

Opportunity is defined as all the factors that lie outside the individual that make
the behaviour possible or prompt it

Question 25

What factors are believed to affect compliance? (8)

Answer 25

1) Asymptomatic conditions: Hypertension
2) Chronic conditions: Hypertension, arthritis, diabetes
3) Cognitive impairment: Dementia, Alzheimer’s
4) Complex regimens: Poly pharmacy
5) Multiple daily dosing
6) Patient perceptions: Effectiveness, side effects, cost
7) Poor communication : Patient practitioner rapport
8) Psychiatric illness: Less likely to comply

Question 26

The 5 WHO Dimensions affecting Adherence

Answer 26

1) Patient Related
2) Socio-Economic
3) Healthcare System Related
4) Clinical Condition Related
5) Therapy Related