PASS S6 - Adherence, homelessness and healthcare

Question 1

Define compliance

Answer 1

The extent to which the patient complies with medical advice

Question 2

Define adherence

Answer 2

The extent to which a person’s behaviour - taking medication, following a diet and/or executing lifestyle changes - corresponds with agreed recommendations from a healthcare provider

Question 3

What are consequences of non-adherence?

Answer 3

Health benefits forgone

Wider economic burden

Question 4

Why don’t people take their medication?

Answer 4

Practical problems

Don’t want to

Question 5

Define unintentional non-adherence

Answer 5

Patients want to follow their treatment but are prevented from doing so by barriers outside of their control
eg. poor recall of instructions, inability to pay, forgetting to take it

Question 6

Define intentional non-adherence

Answer 6

The person decides not to follow the treatment regime

Based on their beliefs, attitudes and expectations

Question 7

Factors that impact on adherence

Answer 7

Beliefs about medication (necessity, side effects etc)
Social support associated with higher adherence
Quality of interaction with, and trust in, healthcare provider

Question 8

What are the five factors in the model of adherence?

Answer 8

Patient factors (beliefs and understanding)
Illness factors (symptoms + severity)
Psychosocial factors (social support)
Treatment factors (side-effects, stigma)
Healthcare factors (setting, Dr-patient interaction)

Question 9

Health needs of the homeless

Answer 9

High risks of serious illness and premature death associated with homelessness
Significant difficulty gaining access to a GP

Question 10

Approaches to providing good healthcare for the homeless

Answer 10

Weekly multi-agency care planning meetings
Homeless nurse practitioner with care navigator supports patient and begins care plan
Regular GP led ward rounds coordinate care, advocate for patient and liaise with community agencies
Charities