Lecture 6.1: Adherence to Treatment Flashcards
What percentage of patients with chronic illnesses don’t take their medication properly?
50 to 60% of patients with chronic illnesses miss doses, take the wrong doses, or drop off treatment in the first year
What is Compliance?
• Extent to which patient conforms or fulfills
medical advice
• Doing what they are told
• Dr. knows best (powerful dr., passive patient)
What is Adherance?
• Extent to which patient behaviour coincides
with medical advice
• Patient-centered, agreement, right to choose,
‘active’ engagement
What is Concordance?
• Doctor-patient negotiation
• Respects patient beliefs and priorities
Why is Concordance important? (3)
• Shared ownership/decision-making
• Barriers to adherence addressed
• Promotes patient trust and satisfaction
Types of Non‐Adherers (5)
1) Consistent Underdoser
2) Consistent Overdoser
3) Random Doser
4) Abrupt Overdoser
5) Tourist (takes “drug holidays”)
Types of Non‐Adherers: Consistent Underdoser
• Regularly neglects to take one of the
prescribed doses
• Such as the midday dose
• Regularly takes only some of the prescribed
medications
Types of Non‐Adherers: Consistent Overdoser
• Regularly takes a drug more often or in larger doses than is prescribed
Types of Non‐Adherers: Random Doser
• Takes the medications when she or he thinks of it
Types of Non‐Adherers: Abrupt Overdoser
• Does not take medications properly and then takes an overdose prior to a
clinic visit
• Doubles up for missed doses
Types of Non‐Adherers: Tourist (takes “Drug Holidays”)
• Abruptly stops all medications for a few days or weeks
• Takes one day off per week
How many more lives could be saved if patients adhered to treatment?
• An estimated 125,000 lives could be saved annually with better medication
compliance
What is the greatest cause of re‐admissions to hospitals?
Non-Adherence
Direct Measures to Observe Adherence (3)
• Urine Test
• Blood Test
• Observation of Consumption
Indirect Measures to Observe Adherence (4)
• Electronic Measures
• Pill Counts
• Repeat Prescription/Pharmacy Records
• Patient Self-Report
Problems with Patient Self-Reporting (4)
• Inaccuracies/Bias
• Tendency to over-report adherence (often 10‐20% higher)
• Second-hand reports
• Depends on familiarity with patient
Problems with Repeat Prescription/Pharmacy Record (2)
• Subject to inaccuracy (lost pills)
• Do not measure when/if medication taken correctly
What comes under “Unintentional Non-Adherence”? (4)
• Lack of understanding of instructions
• Forgetting instructions/doses
• Difficulty following prescribed regimen
• Problems accessing treatment
What comes under “Intentional Non-Adherence”? (2)
• Reasoned decision
• Beliefs, attitudes, expectations
Factors believed to affect Compliance: Patient Barriers (6)
• 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)
Factors believed to affect Compliance: Health Beliefs (3)
• How serious is my disease
• What are the sequences of being careless in treating the disease
• Self Efficiency
What is Capability?
• 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.
What is Motivation?
Brain processes that energise and direct behaviour
What is Opportunity?
Opportunity is defined as all the factors that lie outside the individual that make
the behaviour possible or prompt it
What factors are believed to affect compliance? (8)
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
The 5 WHO Dimensions affecting Adherence
1) Patient Related
2) Socio-Economic
3) Healthcare System Related
4) Clinical Condition Related
5) Therapy Related
