Psychology 3a - Adherence to Treatment Flashcards
Define compliance
Compliance refers to the extent to which patients follow doctors’ prescription about medicine taking.
Define adherence
- Adherence refers to the extent to which patients follow through decisions about medicine taking.
- Requires patients agreement
- Wide spectrum of behaviour (under or over-adherence can occur)
Define concordance
Concordance refers to the extent to which patients are successfully supported both in decision making partnerships about medicines and in their medicines taking.
List the causes of non-adherence
- Forgetting to take medication
- Not doing physio because it takes time/effort
How is non-adherence measured?
Direct methods:
- Directly observed therapy
- Measurement of medicine in the blood
- Measurement of biological markers
Indirect methods:
- Patient questionnaire
- Patient self-report
- Pill counts
- Rates of prescription refills
- Electronic medication monitors
- Patient diaries
List the pros and cons of direct measurement of non-adherence
- Patient cannot lie if measuring blood for example
- However, produces distrust and is expensive
List the impact and consequences of non-adherence
- 50% average rate of adherence in long-term conditions
- Poor health outcomes
- Increased healthcare costs
In USA
- 10% hospital admissions
- Causes nearly 125000 deaths per year
- Costs healthcare system $100-289 billion a year
List theories of non-adherence
- Was previously believed non-adherence is a result of poor communication, however information does not solve adherence
- Unintentional non-adherence (patient ability and resources, physical barriers)
- Intentional non-adherence (patient beliefs and motivations, perceptual barriers to adherence)
- Overlap between unintentional and intentional occurs
- COM-B model
How can the COM-B model be applied to medication adherence?
- Capability and opportunity affect motivation
- Capability, opportunity and motivation have a bidirectional effect on adherence
- Capability is psychological (capacity to engage in necessary thought processes) and physical (capacity to engage in necessary physical processes)
- Motivation is reflective (evaluations and plans) and automatic (emotions and impulses)
- Opportunity is factors outside of the individual that make performance of a behaviour possible or prompt it (physical or social)
How does illness perception affect treatment adherence?
- Causal beliefs predict adherence behaviour in post MI (Weinman et al., 2000)
- Timeline beliefs predict preventer medication adherence in asthma (Horne, Weinman, 2002)
- Causal, timeline and control beliefs predict adherence to CBT in psychosis (Freeman et al., 2013
List the types of specific beliefs
- Views about prescribed medication
- Necessity - is the prescribed medication necessary to maintain health?
- Concerns - arising from beliefs about potential negative effects
- Doubts + concerns results in low adherence
List qualities of patient beliefs about illness and treatment
- Influence adherence
- Have internal logic
- Are influenced by symptoms
- May differ from the “medical view”
- May be based on mistaken beliefs
- May not be disclosed in the consultation
- Are not set in stone and can be changed
List the ways to improve adherence
- Interventions to improve understanding of illness and treatment, and help patients to plan and organise their treatment
- Using a consultation to facilitate informed adherence (check patient understanding; provide clear rationale for necessity of the treatment; elicit and address concerns; agree a practical plan as to how, when, and where to take treatment; and identify any possible barriers)
List examples of interventions to improve adherence
- Petrie et al. (2012) A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication.
- O’Carroll et al. (2013) Improving adherence to medication in stroke survivors. Targetted patient beliefs about medication and introduced a paln using 2 sessions.
