Treatment Adherence

Question 1

What is compliance?

Answer 1

the action or fact of applying with a wish or command

• refers to the extent to which patients follow doctors’ prescription about medicine taking

Question 2

What is adherence?

Answer 2

attachment or commitment to a person, cause, or belie

• refers to the extent to which patients follow through decisions about medicine taking

Question 3

What is concordance?

Answer 3

refers to the extent to which patients are successfully supported both in decision making partnerships about medicines and in their medicines taking

Question 4

How can you measure non-adherence?

Answer 4

Direct methods include:

• Directly observed therapy
• Measurement of level of medicine/metabolite in the blood
• Measurement of biologic marker in the blood

Indirect methods include:

• Patient questionnaire
• Patient self-report
• Pill counts
• Rates of prescription refills
• Electronic medication monitors
• Patient diaries

Question 5

What are the impacts of non-adherence?

Answer 5

Poor health outcomes, which in turn leads to increased healthcare costs

Question 6

What is the COM-B model of behaviour?

Answer 6

the performance of a behaviour is caused by the interaction between:

• Capability
• Opportunity
• Motivation

Question 7

How can COM-B be applied to medication and adherence?

Answer 7

There is a bi-directional relationship between many of these elements. Adherence is a continuum (we mustn’t forget about over-adherence

capability (psychological) - e.g comprehension of disease and treatment
motivation (reflective) - e.g perception of illness/beliefs about treatment
opportunity (physical) - e.g cost, acess

Question 8

How does illness perception affect adherence?

Answer 8

Some illness perceptions are associated with treatment adherence in some conditions e.g causal beliefs predict adherence behaviour in post MI, timeline beliefs predict preventer medication adherence in asthma

• However, illness beliefs per se are not the strongest predictors of treatment adherence, and other more proximal factors, i.e. patient beliefs about treatment, need to be considered.

Question 9

What are some ways to improve adherence?

Answer 9

Interventions to:

• Improve understanding of illness and treatment (influence patient beliefs about illness)
• Help patients to plan and organise their treatment (practical barriers can get in the way)

Using the consultation to facilitate informed adherence:
- Check the patient’s understanding of treatment, and if necessary:
> Provide a clear rationale for the necessity of treatment
> Elicit concerns that they may have regarding treatment, and addressing these concerns
> Agree a practical plan for how, where and when to take treatment
> Identify any possible barriers