Patient Adherence 8/27/13

Question 1

factors affecting patient adherence

Answer 1

concern about side effects, cost, conditions improved, forgetfulness, limited access to healthcare, poor relationship with doctor, missed appointment, complexity of treatment, depression, difficulty remembering schedule, lack of understanding, not feeling sick, embarrassment, belief system, health literacy.

Question 2

50% rule

Answer 2

• 50% of patients leave the office not understanding what the MD said
• 47% could not repeat the Mds instructions

Question 3

describe strategies for enhancing patient adherence

Answer 3

• patient education
• dosing schedules- simiple dosing and frequent vists
• write it down and repeat often
• increased clinic hours
• improved communication
• DOT- directly observed therapy and treatment adherence
• motivational interviewing
• acceptance and commitment therapy (ACT)- mindfulness- how to lead a healthy life

Question 4

what is the most important factor in determining adherence?

Answer 4

Improved communication

the less time spent discussing meds= lower adherence

Question 5

What is DOT

Answer 5

directly observed therapy and treatment adherence

-supervised swallowing of meds to improve adherence

Question 6

describe the major questions a physician should consider when approaching a behavioral health issue?

Answer 6

how does this effect the persons life in other ways?

they need to feel uncomfortable to adhere to what needs to be done- they need a bigger reason to change

Question 7

describe the elements of functional analysis

Answer 7

• its a scientific, systematic approach to understanding the individual case- can get a base line and then track change or an idea of what might help
• interested in the function or purpose of behavior
• the application of the laws of operant conditioning to establish relationship b/w stimuli and responses
• ABCs

Question 8

What is the premise of functional analysis

Answer 8

all behavior is purposeful

can collect data about the ABCs to design interventions

Question 9

What are the ABCs

Answer 9

Antecedents, Behaviors, Consequences

or Triggers, Behaviors, and payoffs

Question 10

Reinforcement

Answer 10

any consequence that increases the rate of behavior it follows

Question 11

task analysis

Answer 11

breakdown a task into smaller steps and reinforce after each step

Question 12

Shaping

Answer 12

like task analysis for a specific behavior

Question 13

premack

Answer 13

making access to a highly valued reinforcer contingent on engaging in a low probability behavior

Question 14

Cueing

Answer 14

giving a signal that sets off a chain of behavior

Question 15

extinction

Answer 15

ignoring a previously reinforced behavior in order to reduce the frequency of that behavior

Question 16

Time out

Answer 16

negative punishment in which child who engages in negative behavior loses access to positive reinforcers for a brief period

Question 17

over- correction and restituation

Answer 17

positive punishment in which child who engages in negative behavior is required to engage in effortful activity for a brief period

Question 18

Desensitization

Answer 18

feared stimulus is gradually presented using a heirarchy of least to most feared and relaxation is paired with each stimulus until it no longer evokes fear

Question 19

Punishment

Answer 19

negative behavior is followed by a consequence that results in a decrease of the probability of that behavior in the future.

Question 20

Classical conditioning

Answer 20

stimulus– response

Question 21

Operant conditioning

Answer 21

usually a negative reinforcement- shocking a mouse. punishment. extinction