medicine adherance & concordance Flashcards
define adherence
the extent to which the patient’s actions match agreed recommendations
how many medicines for chronic conditions are not prescribed
30-50% of medicines for chronic conditions not taken a prescribed – costs £12.9 billion a year
what is compliance
assumes doctor knows best – passive patient – patient should follow doctors orders
what does adherence do
acknowledges importance of patient’s belief but health professional still expert in conveying their knowledge
benefits of communication
Communication to enhance patient knowledge, satisfaction and adherence to the recommended medial regime
what is needed to support adherence
More patient-centered approach needed to support adherence
define necessity beleifs
perceptions of personal need for treatment
concerns about a range of potential adverse consequence
describe patient-centeredness
Shift in focus from treatment to the process of care
what 2 things does patient-centeredness encourage
1.Focus in the consultation on the patient was a whole person who has individual preferences situated in a social context
- Shared control of the consultation, decisions about interventions or management of health problems with the patient
4 impacts of good dr-patient communication
- Better health outcomes
- Higher adherence to therapeutic regimens in patients
- Higher patient and clinician satisfaction
- Decrease in malpractice risk
what are the 6 key principles
- improve communication
- increase patient involvement
- understand the patients perspective
- provide information
- assess adherence
- review medicines
2 ways to improve communication
Adapt consultation style to the patient’s needs
Encourage patients to ask questions
3 ways to increase patient involvement
Explain condition, pros and cons of treatment
Clarify what the patient hopes the treatment will achieve
Record the decision if the patient decides not to take a medicine and this could be harmful
2 ways to understand the patients perspective
Ask patients what they know, believe and understand about their
medicines and treatment
Ask of any concerns they have
2 ways to provide information
Offer patients clear relevant information on their condition and possible treatments – discuss rather than present info
Offer individualized information that is easy to understand and free from jargon
2 ways to assess adherence
Routinely assess adherence in a non-judgmental way whenever you prescribe, dispense and review medicines
Consider using records to identify potential non-adherence
2 ways to review medicines
Review patient’s knowledge, understanding and concerns about medicines
Ask about adherence when reviewing medicines
describe concordance
Extension of principles of patient centered medicine
Rather than thinking about health care relationships as a means of enforcing the doctor’s instructions, we now think about patients more as equals in care
It is expected that patients will take part in treatment decisions and have a say in the consultation
3 barriers to concordance to do with patients
Do patients want to engage in discussion with their doctor
Research indicated that in some cases it might serve to worry the patient more
Patients may simply want the doctor to tell them what to do, where medical decisions were complex or based on complicated statistical risks
3 barriers to concordance to do with healthcare professionals
Relevant communication skills
Time/resources/ organizational constraints
Challenging – patient choice V evidence
10 steps to sharing decision making with patients
- Define the problem, taking in yours and patient’s views
- Convey that professionals may not have a set opinion about the best treatment, even when patient priorities are taken into account
- Outline the options and, if relevant, the consequences of no treatment
- Provide information in preferred format
- Check the patient’s understanding of the options
- Explore the patient’s concerns and expectations about the condition, treatment options and outcomes
- Check the patient accepts the decision sharing process
- Involved the patient in the decision-making process to the extent the patient wishes
- Review the needs and preferences after the patient has had time for further consideration
- Review treatment decisions over time
