Lecture 8B Flashcards
What is the difference between compliance and adherence?
Compliance is the extent to which the patient complies with medical advice (does what they’re told)
Adherence is a measure of the degree to which a patients decisions and actions align with your recommendations
Adherence is used now as compliance has negative connotations
What does non-adherence to medication involve?
Not picking up a prescription
Taking too much or two little
Taking at the wrong times
Taking some but not all medication
What is adherence like in the community?
Can be very low eg 33% for COPD.
It also reduces over time and trends to increase with the severity of the disease
Is non adherence costly?
Yes, between patients falling ill and requiring healthcare services and the wastage of unused drugs
How much adherence is required?
Varies with each condition, some require 90% others eg hypertension require only 80%
What is a direct measure of adherence?
Urine tests
Disadvantages include the fact that it needs to be done in a clinical setting, invasive, expensive and results can be masked if meds not taken as prescribed
What indirect adherence measures are there?
Pill counts
Mechanical or electronic measures of dose
Patient self report
Second hand reports
Why dont patients adhere?
Can be intentional or unintentional
What are common factors that form patients belief about illness?
Severity, symptoms and whether they understand it as chronic or episodic
What does chronic and episodic mean when it comes to patients understanding of their symptoms?
Chronic means that they believe the illness is present all the time even when it isn’t affecting them= adherent
Episodic= believe that the disease is only affecting them when they have symptoms= non-adherent
What other factors impact on patient adherence?
Social support and the quality of interaction and trust in their healthcare provider
What factors contribute to adherence?
Patient factors- beliefs, memory etc
Psychosocial factors-social support etc
Illness factors- severity and symptoms
Treatment factors- side effects, stigma
healthcare factors- setting, doctor patient communication
What is concordance??
Where the patient has active involvement in establishing their treatment regimes in which their beliefs and priorities are respected
