medicine adherance & concordance

Question 1

define adherence

Answer 1

the extent to which the patient’s actions match agreed recommendations

Question 2

how many medicines for chronic conditions are not prescribed

Answer 2

30-50% of medicines for chronic conditions not taken a prescribed – costs £12.9 billion a year

Question 3

what is compliance

Answer 3

assumes doctor knows best – passive patient – patient should follow doctors orders

Question 4

what does adherence do

Answer 4

acknowledges importance of patient’s belief but health professional still expert in conveying their knowledge

Question 5

benefits of communication

Answer 5

Communication to enhance patient knowledge, satisfaction and adherence to the recommended medial regime

Question 6

what is needed to support adherence

Answer 6

More patient-centered approach needed to support adherence

Question 7

define necessity beleifs

Answer 7

perceptions of personal need for treatment

concerns about a range of potential adverse consequence

Question 8

describe patient-centeredness

Answer 8

Shift in focus from treatment to the process of care

Question 9

what 2 things does patient-centeredness encourage

Answer 9

1.Focus in the consultation on the patient was a whole person who has individual preferences situated in a social context

2. Shared control of the consultation, decisions about interventions or management of health problems with the patient

Question 10

4 impacts of good dr-patient communication

Answer 10

• Better health outcomes
• Higher adherence to therapeutic regimens in patients
• Higher patient and clinician satisfaction
• Decrease in malpractice risk

Question 11

what are the 6 key principles

Answer 11

1. improve communication
2. increase patient involvement
3. understand the patients perspective
4. provide information
5. assess adherence
6. review medicines

Question 12

2 ways to improve communication

Answer 12

Adapt consultation style to the patient’s needs

Encourage patients to ask questions

Question 13

3 ways to increase patient involvement

Answer 13

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

Question 14

2 ways to understand the patients perspective

Answer 14

Ask patients what they know, believe and understand about their

medicines and treatment
Ask of any concerns they have

Question 15

2 ways to provide information

Answer 15

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

Question 16

2 ways to assess adherence

Answer 16

Routinely assess adherence in a non-judgmental way whenever you prescribe, dispense and review medicines

Consider using records to identify potential non-adherence

Question 17

2 ways to review medicines

Answer 17

Review patient’s knowledge, understanding and concerns about medicines

Ask about adherence when reviewing medicines

Question 18

describe concordance

Answer 18

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

Question 19

3 barriers to concordance to do with patients

Answer 19

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

Question 20

3 barriers to concordance to do with healthcare professionals

Answer 20

Relevant communication skills

Time/resources/ organizational constraints

Challenging – patient choice V evidence

Question 21

10 steps to sharing decision making with patients

Answer 21

1. Define the problem, taking in yours and patient’s views
2. Convey that professionals may not have a set opinion about the best treatment, even when patient priorities are taken into account
3. Outline the options and, if relevant, the consequences of no treatment
4. Provide information in preferred format
5. Check the patient’s understanding of the options
6. Explore the patient’s concerns and expectations about the condition, treatment options and outcomes
7. Check the patient accepts the decision sharing process
8. Involved the patient in the decision-making process to the extent the patient wishes
9. Review the needs and preferences after the patient has had time for further consideration
10. Review treatment decisions over time