RIM Concordance

Question 1

What is medication Adherence?

Answer 1

Taking your medication exactly as directed by your doctor, nurse, pharmacist or other health professional.

Question 2

RIM Concordance

What is Concordance vs. Adherence?

Answer 2

Adherence is sticking to the therapuetic plan. Concordance is shared decision making batween health care provider and patient to have improved outcomes.

Question 3

RIM Concordance

Reasons of medication non-concordance

Answer 3

failure to respond, additional medications, additional need for health care, adverse effects.

Question 4

RIM Concordance

Most common types of non-concordance

Answer 4

failing to fill prescription, taking incomplete dose, taking at the wrong time, forgetting dose, stopping the medication.

Question 5

RIM Concordance

concordance risk factors.

Answer 5

multiple medications, difficult route of administration, difficult preparation required, adverse drug reactions, lack of confidence in therapy, fear of addiction, caregiver giving med, irregular hours, poor health literacy.

Question 6

RIM Concordance

Three elements to medication concordance

Answer 6

The KNOW HOW. BE ABLE TO. WANT TO.

Question 7

RIM Concordance

concordance behaviors.

Answer 7

knowledge deficit, motivational, practical impediments (behavioral). In acute disease have a pyramid. understanding lower level (KNOW HOW), then motivational (WANT TO), top is behavioral (ABLE TO). pyramid is flipped for chronic disease.

Question 8

RIM Concordance

RIM

Answer 8

Recognize non-concordance. Identify the cause. Manage.

Question 9

RIM Concordance

Recognition of Non-concordance (SO from SOAP)

Answer 9

1. Subjective Evidence. all about the patient’s perspective. pink flags. 2. Objective evidence (patient profile, computerized concordance monitors, blood serum concentrations, signs of the disease)

Question 10

RIM Concordance

Supportive Statements with Probes : identifying non-concordance when subjective and objective evidence does not match

Answer 10

clear description of facts, listen to check the patient’s info, “I” statement of concern, Question (probe), specify what actions you would like to see taken, emphasize positive results.

Question 11

RIM Concordance

Universal statements (tactful bridges)

Answer 11

“most people think that…”, “frequently, my patients have difficulty…”, use when you know there is a pink flag.

Question 12

RIM Concordance

Patient centered goals

Answer 12

encourage patient to express concerns, help them to be more active in consultations, help them articulate what info they need, help them have greater control over decisions, reach joint decisions, use prime questions with final verification.

Question 13

Define Pink Flag

Answer 13

Sublte verbal and/or nonverbal signal that patient may not know how, be able to, or want to use a medication as prescribed.

Question 14

Under Identify: What are the types of barriers that can cause non-concordance?

Answer 14

knowledge deficit (know how), motivation (want to), functional (be able to)

Question 15

State the purpose of “M”

Answer 15

Manage non-concordance. need to know the type of non-concrodance (knowledge, motivation, practical). use open-ended questions, reflection, and summary.