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HDHP > MI and Adherence > Flashcards

MI and Adherence Flashcards

1
Q

Define motiviation

A

State of readiness/eagerness to change

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2
Q

Overall aims of an MI?

A

Help patients identify and change behaviours that may be placing them at risk of health problems or preventing optimal management of a chronic condition

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3
Q

How does the MI help the patient?

A

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

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4
Q

What strategies are used in an MI?

A 
Give advice
Remove barriers
Provide choice about their decisions
Decrease desirability
Practise empathy
Feedback
Clarify goals
Active helping
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5
Q

Principles of MI?

A 
Express empathy
Avoid argument
Support self-efficacy
Roll with resistance
Develop discrepancy
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6
Q

How do you carry out an MI?

A 
Establish rapport
Set agenda
Assess readiness to change
Identify ambivalence
Elicit self-motivating statement
Sharpen focus
Handle resistance
Shift the focus
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7
Q

Define adherence

A

Extent to which patient behaviour coincides with medical advice

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8
Q

Define compliance

A

Extent to which patient complies with medical advice

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9
Q

Define concordance

A

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)

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10
Q

How does achieving concordance lead to better adherence?

A

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

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11
Q

What is adherence like in chronic illness?

A

24.8% are non-adherent

Accounts for 10-25% of hospital admissions

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12
Q

Which illnesses have the highest rates of adherence?

A

HIV
Arthritis
GI disorders
Cancer

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13
Q

Which illnesses have the highest rates of non-adherence?

A

Pulmonary disease
Diabetes
Sleep disorders

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14
Q

What techniques are there for measuring adherence?

A

Pill counts
Mechanical/electronic measures of dose
Urine/blood tests
Observation

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15
Q

Disadvantage of pill counts?

A

Inaccuracies such as lost pills

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16
Q

Example of mechanical/electronic measure of dose?

Advantages and disadvantages?

A

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

17
Q

Advantages and disadvantages of urine and blood tests?

A

Advantage - provides most direct measure of consumption/adherence
Disadvantage - Expensive, limited to use in clinical practice, invasive, affected by metabolism

18
Q

What patient factors influence adherence?

A

Undestanding of

  • info and content of the consultation
  • illness
  • body
  • treatment

Recall of

  • name of drug
  • frequency of dose
  • duration of treatment
19
Q

What illness and disease factors influence adherence?

A

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

20
Q

What are treatment factors that influence adherence?

A

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

21
Q

How does the health belief model relate to adherence?

A

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

22
Q

What psychological factors can affect adherence?

A

Cognitive deficiencies/psychological problems eg depression - less likely to adhere to medications for chronic illnesses

23
Q

What social factors can affect adherence?

A

Socially isolated patients are less likely to adhere
Social support is associated with higher adherence
Family support
Homelessness

24
Q

What healthcare factors can affect adherence?

A

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
25
Q

Define intentional non-adherence

A

Arises from beliefs, attitudes and expectations that influence patient’s motivation to begin and persist with the treatment regimen

26
Q

Define unintentional non-adherence

A

Arises from capacity and resource limitations that prevent patients from following treatment recommendations

27
Q

What can contribute to unintentional non-adherence?

A

Individual constraints eg memory, dexterity

Aspects of their environemnt eg problems accessing presciption, competing demands

28
Q

What approaches can be taken to improve adherence?

A

Address practical behaviours

Address perceptual factors influencing motivation

29
Q

What is the effectiveness like for interventions to improve adherence?

A

Broardly effective, but with small effects

Better in comprehensive interventions (combining approaches) than those that focus on a single cause

30
Q

What problems are there with interventions to improve adherence?

A

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

31
Q

How can there be greater concordance in prescribing?

A

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

HDHP (14 decks)

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