Medicines Adherence & Concordance Flashcards
According to WHO (2003), what proportion of patients do not take medications for chronic conditions correctly?
30-50%
What is primary non-adherence?
Patient not redeeming/collecting their prescription
What is secondary non-adherence?
Patient collects prescription but does not take as prescribed
What is intentional non-adherence?
Patient makes conscious decision not to make medicine as prescribed.
Influenced by health beliefs, confidence and illness perceptions.
What is unintentional non-adherence?
Patient willing to adhere but unable.
From cognitive and physical barriers.
What type of non-adherence is forgetting?
Intentional AND unintentional non-adherence.
NOT CLEAR CUT!
State treatment-related factors of medication adherence (up to 6)
- Disease area and type of medicine
- Experience of side effects
- Dosage forms
- Ease of accessibility to medicines (packaging)
- Duration of therapy
- Dosing regimen complexity
State prescriber/healthcare-related factors of medication adherence
- Trust in prescriber
- Provision of information
- Resource availability
- Patient and prescriber interaction
State patient-related factors of medication adherence
- Illness perceptions and health beliefs (strong association)
- Socio-demographics (weak association)
- Cognitive ability e.g. memory and health literacy
- Social stigmas
- Beliefs about medicines (necessity vs concerns)
- Social support
- Medication costs
- Co-morbidities e.g. depression, anxiety and illicit drug use
Which model aids in understanding patient adherence?
COM-B (Michie et al, 2011)
Outline COM-B model of medicine adherence
Capability = Physical and psychological Opportunity = Physical and social Motivations = Reflective and automatic
According to Nueuwlaat et al (2014) Cochrane review, what is the single best intervention for improving adherence?
How large have improvements been?
There wasn’t a single effective intervention…
Effects were moderate at best
What are paternalistic approaches to improving adherence?
Is this effective?
Approach includes education and persuasive advice.
These are not effective - health beliefs and perceptions are overlooked…
What is a major limitation of compliance aids?
Many medicines cannot go into the compliance aids
Outline health coaching in medication adherence
Encouraging active participation of patient in self-management, with active listening, goal setting and action planning.
Patients expert on themselves.
