MI and Adherence Flashcards
Define motiviation
State of readiness/eagerness to change
Overall aims of an MI?
Help patients identify and change behaviours that may be placing them at risk of health problems or preventing optimal management of a chronic condition
How does the MI help the patient?
Understand their thought processes related to the problem
Identify and measure emotional reactions to the problem
Identify how thoughts and feelings interact to produce patterns in behaviour
Challenge his/her thought patterns and implement alternative behaviours
What strategies are used in an MI?
Give advice Remove barriers Provide choice about their decisions Decrease desirability Practise empathy Feedback Clarify goals Active helping
Principles of MI?
Express empathy Avoid argument Support self-efficacy Roll with resistance Develop discrepancy
How do you carry out an MI?
Establish rapport Set agenda Assess readiness to change Identify ambivalence Elicit self-motivating statement Sharpen focus Handle resistance Shift the focus
Define adherence
Extent to which patient behaviour coincides with medical advice
Define compliance
Extent to which patient complies with medical advice
Define concordance
Negotiation between patient and doctor over treatment regimes. Patient beliefs and priorities are respected. Patient is active and can make decisions in partnership with the doctor
(REFERS TO INTERACTION BETWEEN PATIENT AND DOCTOR, NOT PATIENT’S MEDICINE-TAKING BEHAVIOUR)
How does achieving concordance lead to better adherence?
Patient is involved in and has shared ownership of decisions about treatment
Patient’s beliefs, expectations, lifestyle and priorities can be taken into account
Barriers to adherence can be addressed
Promotes patient trust and satisfaction with care which makes adherence more likely
What is adherence like in chronic illness?
24.8% are non-adherent
Accounts for 10-25% of hospital admissions
Which illnesses have the highest rates of adherence?
HIV
Arthritis
GI disorders
Cancer
Which illnesses have the highest rates of non-adherence?
Pulmonary disease
Diabetes
Sleep disorders
What techniques are there for measuring adherence?
Pill counts
Mechanical/electronic measures of dose
Urine/blood tests
Observation
Disadvantage of pill counts?
Inaccuracies such as lost pills
Example of mechanical/electronic measure of dose?
Advantages and disadvantages?
Record time at which container was opened
Advantages - objectively measures if a dose has been dispensed, more accurate than other indirect measures
Disadvantages - doesn’t measure if medication has actually been taken
Advantages and disadvantages of urine and blood tests?
Advantage - provides most direct measure of consumption/adherence
Disadvantage - Expensive, limited to use in clinical practice, invasive, affected by metabolism
What patient factors influence adherence?
Undestanding of
- info and content of the consultation
- illness
- body
- treatment
Recall of
- name of drug
- frequency of dose
- duration of treatment
What illness and disease factors influence adherence?
Symptoms - adherence is better when the patient experiences symptoms
Severity
-in less serious diseases, patients with poorer health have better adherence
-in more serious diseases, patients with poorer health are less likely to adhere
What are treatment factors that influence adherence?
Preparation - treatment time, setting, waiting time, timing of referral, convenience, poor reputation
Immediate character - complexity of regimen, duration, degree of behaviour change, convenience, expense, inadequate labels, container design
How does the health belief model relate to adherence?
The more a medication accords with patient’s beliefs, the more likely they are to adhere
The extent of adherence depends on perceived disease severity, perceived susceptibility to disease, benefits of treatment, barriers to following treatment
What psychological factors can affect adherence?
Cognitive deficiencies/psychological problems eg depression - less likely to adhere to medications for chronic illnesses
What social factors can affect adherence?
Socially isolated patients are less likely to adhere
Social support is associated with higher adherence
Family support
Homelessness
What healthcare factors can affect adherence?
Organisational settings
- primary v secondary care
- initial v follow-up consultation
- links between inpatient and outpatient service
- regular follow up
The prescriber
-their beliefs and attitudes towards treatment
Doctor-patient interaction
- perceived manner
- positive behaviours
- communication
- perceived competence
Define intentional non-adherence
Arises from beliefs, attitudes and expectations that influence patient’s motivation to begin and persist with the treatment regimen
Define unintentional non-adherence
Arises from capacity and resource limitations that prevent patients from following treatment recommendations
What can contribute to unintentional non-adherence?
Individual constraints eg memory, dexterity
Aspects of their environemnt eg problems accessing presciption, competing demands
What approaches can be taken to improve adherence?
Address practical behaviours
Address perceptual factors influencing motivation
What is the effectiveness like for interventions to improve adherence?
Broardly effective, but with small effects
Better in comprehensive interventions (combining approaches) than those that focus on a single cause
What problems are there with interventions to improve adherence?
Many lack theoretical input - difficult to tell why some interventions work and others don’t
Few are truly patient-centred - lack of individualising approach to match patient’s needs and preferences
How can there be greater concordance in prescribing?
Specify the problem, look at your own and patient’s views
Equipoise - make it clear there are no set opinions about which treatment is best
Describe treatment options
Describe consequences of no treatment
Give info in preferred format
Check patient understanding of preferred options
Elicit patient’s concerns and expectations
Ascertain patient’s preferred role in decision making
Defer if necessary - review needs and preferences after patient has considered it with family and friends
Review decisions after a specified time period
