Session 6 - Adherence and healthcare for homeless people

Question 1

Explain compliance, adherence and concordance

Answer 1

Compliance used to be used, but now, we use adherence as a most positive word

(OLD) Compliance - the extent to which an individual complies with medical advice (patient does what they’re told!)

(NEW) Adherence - the extent to which a person’s behaviour corresponds with the agreed recommendations from a healthcare provider

Concordance - is synonymous with patient-centred care where the doctor and patient agree therapeutic decisions that incorporate their respective views

Question 2

Describe the consequences of non-adherence to medical advice

Answer 2

• Health benefits disappear (increased hospitalisations etc.)
• Wider economic burden (prescribed medication not collected etc.)

Question 3

Describe the 2 types of non-adherence

Answer 3

Unintentional non-adherence = have practical problems (barriers outside their control)
- Poor recall
- Difficulty administering the treatment
- Inability to pay for the treatment 
- Forgetting to take it
= More work done on this 

Intentional non-adherence = just don’t want to

• Decides not to follow regime
• Based on beliefs, attitudes and expectations

Other factors affecting adherence:

• Social support
• Quality of interaction and trust with their healthcare provider

Question 4

Outline the 5 factors that influence adherence (star diagram)

Answer 4

• Patient factors e.g. beliefs and understanding
• Psychosocial factors e.g. social support
• Healthcare factors e.g. setting, communication
• Treatment factors e.g. side effects, complexity
• Illness factors e.g. severity of symptoms

Question 5

Outline the 3 factors that contribute to chronic homelessness (tri-morbidity)

Answer 5

• Physical ill health
• Mental ill health
• Substance misuse