S1 7 - Adherence with treatment

Question 1

Define ‘adherence.’

Answer 1

the extent to which a patient’s behaviour coincides with medical advice’
the term ‘adherence’ is now preferred to ‘compliance’ which is too paternalistic, not passive enough

Question 2

Compare ‘compliance’ and ‘adherence.’

Answer 2

- Compliance:
Paternalistic
Passive
Episodic
- Adherence:
Collaborative
Active
Continuous

Question 3

Why does adherence with treatment matter?

Answer 3

seen as essential to patient’s recovery
financial implications including readmission to hospital
development of resistance strains of bacteria and better for the patient

Question 4

State and explain the 7 factors affecting adherence with treatment.

Answer 4

1. Patient characteristics
   - age, personality, attitude towards illness, self-efficacy/self-belief, motivation, current health (e.g. depression), health beliefs
2. Regimen characteristics
   - the complexity of regimen, number of regimens, number of times per day, lifestyle changes required
3. Clinician-patient interaction
   willingness to listen, perception of referring clinician, understanding, expectations
4. Type of illness
   acute or chronic, whether patient sees improvement in their condition, side effects and quality of life, previous experience of healthcare
5. Characteristics of the setting
   medical setting v home
6. Amount of support and encouragement
   family, friends, health professionals
7. Impact on life
   loss of pay, transport, the convenience of location for treatment

Question 5

State 9 ways to improve adherence.

Answer 5

Patient must decide to follow advice
Patient must understand treatment and rationale for it
Give clear information
Good relationship with clinician
Improve communication skills, get patients to repeat key information in their own words
Tailor regimen to the patient
Patient must feel that they are being taken seriously
Make visits easier
Provide reminders and prompts - for exercises and for visits etc

Question 6

What 2 things do you need to take into account with adherence?

Answer 6

Cultural beliefs

Individual social/psychological problems

Question 7

What 4 things did Ley (1988) claim that adherence can be predicted by a combination of?

Answer 7

patient satisfaction with the process of the consultation
understanding of the information given
recall of this information
(cognitive hypothesis model of adherence)

Question 8

What is important to remember when giving information to a patient?

Answer 8

Patients forget much of what they have been told
Instructions and advice are more likely to be forgotten
The more a patient is told, the more they forget
Older patients remember as much as younger patients
Patients will remember what is told first and what they consider most important
Remember – we can all fall into the trap of hearing what we want to hear!
Moderately anxious patients remember more than highly anxious or non-anxious patients
The more medical knowledge a patient has, the more they will remember

Question 9

What needs to be understood about adherence?

Answer 9

Need to understand issues of non-adherence from the patient perspective
It is not always the patient’s ‘fault’ that they do not follow guidance
Non-adherence can be deliberate and based on valid reasons = rational non-adherence

Question 10

State 6 reasons why a patient decide might not to continue to adhere to medical advice.

Answer 10

Belief that the medication is not working
Side effects are unpleasant
Confused about what to do when
Cannot afford the next prescription
Want to see if the illness is still there
They feel better
Also, unintentional non-adherence = forgetting!