meds adherence and concordance

Question 1

define adherence

Answer 1

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

Question 2

describe compliance

Answer 2

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

Question 3

describe adherence

Answer 3

-acknowledges importance of patient’s belief but health professional still expert in conveying their knowledge
-Communication to enhance patient knowledge, satisfaction and adherence to the recommended medial regime
-More patient-centered approach needed to support adherence

Question 4

define necessity beliefs

Answer 4

perceptions of personal need for treatment
-concerns about a range of potential adverse consequences

Question 5

describe patient centredness

Answer 5

Shift in focus from treatment to the process of care

Question 6

what does patient centeredness care encourage

Answer 6

-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

Question 7

what is the impact of good DR patient communication?

Answer 7

1.Better health outcomes
2.Higher adherence to therapeutic regimens in patients
3.Higher patient and clinician satisfaction
4.Decrease in malpractice risk

Question 8

what are the key principles to consider for a good DR patient relationship?

Answer 8

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

Question 9

how would you be able to improve communication in a consultation?

Answer 9

A. Adapt consultation style to the patient’s needs
B. Encourage patients to ask questions

Question 10

how would you be able to increase patient involvement in a consultation?

Answer 10

A. Explain condition, pros and cons of treatment
B. Clarify what the patient hopes the treatment will achieve
C. Record the decision if the patient decides not to take a medicine and this could be harmful

Question 11

How would you be able to understand the patients perspective in a consultation?

Answer 11

A. Ask patients what they know, believe and understand about their medicines and treatment
B. Ask of any concerns they have

Question 12

How would you be able to provide information in a consultation?

Answer 12

A. Offer patients clear relevant information on their condition and possible treatments – discuss rather than present info
B. Offer individualized information that is easy to understand and free from jargon

Question 13

How would you be able to assess adherence in a consultation?

Answer 13

A. Routinely assess adherence in a non-judgmental way whenever you prescribe, dispense and review medicines
B.Consider using records to identify potential non-adherence

Question 14

how would you be bale to review medicines in a consultation?

Answer 14

A. Review patient’s knowledge, understanding and concerns about medicines
B. Ask about adherence when reviewing medicines

Question 15

what is concordance?

Answer 15

it is an extension of patient centred medicine
instead of enforcing drs instructions- more equal in care
patients take part in treatment decisions and have a say in consultation

Question 16

what are the barriers to concordance?

Answer 16

-patients
-health professionals

Question 17

how are patients barriers to concordance?

Answer 17

1. Do patients want to engage in discussion with their doctor
   2.Research indicated that in some cases it might serve to worry the patient more
   3.Patients may simply want the doctor to tell them what to do, where medical decisions were complex or based on complicated statistical risks

Question 18

how can health professionals be barriers to concordance ?

Answer 18

-Relevant communication skills
-Time/resources/ organizational constraints
- Challenging – patient choice V evidence

Question 19

10 steps on how to share decision making with patients

Answer 19

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

Question 20

what does medicines optimisation look at?

Answer 20

• the value in which medicine deliver- makes sure they are clinically effective and cost effective.
• ensuring people get the right choices of medicine at the right time

Question 21

what are the goals of medicines optimisations?

Answer 21

-Improve their outcomes
-Take their medicines correctly
-Avoid taking unnecessary medicines
-Improve medicines safety
-Reduce wastage of medicines

Question 22

name some examples of non adherence

Answer 22

-Not taking prescribed medication
-Taking bigger/smaller doses than prescribed
-Taking medication more/less often than prescribed
-Stopping the medicine without finishing the course
-Modifying treatment to accommodate other activities(work, social)
-Continuing with behaviours against medical advice(diet, alcohol, smoking)

Question 23

what are the unintentional reasons for adherence?

Answer 23

Practical barriers-
-Difficulty understanding instructions
-Poor dexterity
-Inability to pay
-Forgetting
CAPACITY AND RESOURCES

Question 24

what are the intentional reasons for adherence?

Answer 24

Motivational barriers
-Patients’ beliefs about their health/condition
-Beliefs about treatments
-Personal preferences
PERCEPTUAL BARRIERS

Question 25

what are the ethical considerations with decisions?

Answer 25

mental capacity act 2005

Question 26

ethical considerations to consider when patient is a child?

Answer 26

-3rd party (parents/guardians)
-When can children take responsibility for their treatment?
-Should more weight be given to the parents’ wishes or the child’s?
-What if the parent, child, and doctor all disagree?