Week 4 Flashcards
what is adherence
- a self initiated action taken to promote wellness, recovery, and rehabilitation
- the extent to which pts follow the instructures they are given for prescribe treatments
- the extent to which a person’s actions or behaviors coincide w advice or instructions from HCP with the intention to prevent, monitor, or ameliorate a disorder
what does adherence range from
- lack of adherence to total adherence
what are 3 categories of consequences for non-adherence
- pt-related
- health professional-related
- healthcare system-related
what is a pt-related consequence of non-adherence (2)
- increased morbidity
- reduced quality of life
what is a health professional-related consequence of non adherence (4)
- lack of empathy
- ambivalence
- decisional conflict
- avoidance
what is a healthcare system related consequence of non adherence
- greater cost of services
adherence is best conceptualized as..
“interest” in completing a certain behavior
what is a significant variable that affects adherence
- motivation
- in addition, the degree or source of motivation may influence the extent of adherence
what are 2 theories of adherence behavior
- theory of planned behavior
- health belief model
what is theory of advanced behavior?
- a model proposing how human action in guided
- postulates that the likelihood of an individual engaging in a health behavior
- relates to the prediction of whether a person intends to do something
what does the health belief model hypothesize (4)
hypothesizes that people are more likely to initiate a health related behavior if…
- they perceive they could become ill or be susceptible to the problem –> perceived susceptibility
- believe the illness has serious outcomes or will disrupt their daily fnxning –> perceived severity
- believe that the required recommendation will be effective in reducing symptoms –> perceived benefits
- believe that there are few barriers to initiating the recommendation –> perceived barriers
what are 3 dimensions of adherence
adherence represents 3 dimensions of thoughts and attitudes regarding pt behavior associated w recommended treatments and therapies
- compliance
- persistence
- concordance
what is compliance
- the behavior of conforming to a set treatment plan for a recommended length of time
- the extent to which the pt’s behavior (in terms of taking meds, following diets, and other lifestyle changes) coincides w the clinical advice
- the act or process of complying to a desire, demand, proposal, or regimen or to coercion, a disposition to yield others
what is persistence r/t adherence
- primarly applies to chronic care
- measures if a pt continues a treatment regime over the long term, even if they are stressed, busy, etc.
- measure of continuation from time of initiation to d/c
ex. how often a pt renews or refills their prescription
what is concordance r/t adherence
- involves negotiation and shared decision making
- suggests that pts and HCP come to a mutual agreement on a regimen thru negotiation and shared decision making
what is noncompliance
- resistance of the individual to follow a predetermined regimen
what does non compliance often result in (3)
- blaming behavior when the pt goals are not achieved
- condemns a pt’s behavior as flawed for the inability to conform to treatment
- very judgemental
describe the expectation of compliance at all times (3)
- unrealistic
- may even be beneficial from the pt to take breaks from exhausting treatment so they can resume with more dedication after time
- may be necessary defensive response to stressful situations
nonadherence occurs when…
- the pt does not follow treatment recommendations that are mutually agreed on
- can be intentional and unintentional
the interplay of what 5 factors can determine nonadherence
- socioeconomics
- pt related
- condition related
- therapy related
- healthcare team/system related
what is locus of control? locus control can be categorized as..
= an individuals sense of responsibility for their own behavior, and the extent to which motivation to take action originated from within the self or is influenced by others
- internal
- external
what is internal locus of control? provide an example
- individuals whose behavior is self-motivated
- believe they control their own destiny
ex. i have a hx of osteoporosis in my family, i will have necessary screenings, eat an approp diet, and do weight bearing exercises to prevent or control this
what is the external locus of control
- individuals who view others as more powerful in influencing health outcomes
- believe that fate is a powerful outside force that determines life’s course
ex. osteoporosis runs in my family, it will catch up w me
discuss the link of locus of control w complicance
- one’s locus of control is not necessarily linked to compliance
what is motivational interviewing
- a collaborative person-centered way of guiding an interview to elicit and strengthen motivation
what are the benefits of using an MI appraoch (5)
- improved adherence to meds
- behavioral intenterventions
- smoking cessation
- reduction in alcohol and rec drug use
- stress reduction
what is the righting reflex
- the urge to jump in, give advice, and set things right before connecting with the pt you’re trying to help
- that is experienced by many HCP when talking to pts
what are the cons of the righting reflex (4)
- may discourage the pt
- inadvertently shaming the pt for their lack of understanding or actions
= push pts to be even more resistant to advice - fails to consider the pts own beliefs and motivations
what is an example of the righting reflex
ex. you have to take ur meds as prescribed
ex. dont you know smoking is bad for you
ex. im sure youd rather take ur meds than end up in the hospital again
what is at the heart of MI
- empathy for the pt
- involves collaborating w the pt
what acronoym is used to describ comunication skills of MI
OARS
what does OARS stand for
Open ended questions
Affirmations
Reflection statements
Summary statements
why should you use open ended questions in MI (3)
- allow for open-ended answers
- invitation for the pt to tell their story in a guided style
- helps open up the pt
how might open questions begin with? what should you use caution w ?
- may begin with how, tell me
- use caution in questions starting with “why” as they may sound judgemental
how might affirmations be used in MI (5) what is an example?
- should be specific to the pt
- highlight something the HCP appreciated about them
- not cheerleading or praising statements
- may credit an afford the pt is making
- should not be condescending
- acknowledge a success
ex. you are being rlly honest about how youre taking ur meds, you came in to talk abt ur health
what is a benefits to using affirmations during MI
- increase positive energy & mood during an interaction
affirmations staring with __ should be avoided
- staring with “I”
ex. I think you’re doing __ great
affirmations are not the same as..? instead they should…?
- they are not the same as agreeing or approving to what the pt is doing
- instead should help build the relationship w the pt by affirming something the pharmacist appreciates
what is the benefit of using reflections in MI (3)
- demonstrate to the pt you are listening & have heard them
- increase possibility of being seen as empathetic
- work towards establishing a good relationship
what do reflections require
- the HCP to select a part of a pt statement that can be more deeply explored and then forma hypothesos about what the pt means
what are different lvls of reflection
- simple to complex
what do simple reflections do
- repeat the pt statement or paraphrase it to show understanding usually in a more concise way
what do complex reflections do
- form a hypothesis about the underlying feelings & meaning in a pt statement
how can education be used to improve adherence (4)
- educate on the consequences of not taking them (ex. harms of uncontrolled HTN)
- educate on benefits of taking (ex. benefits of controlling HTN)
- make education materials widely available
- demonstrate that alternatives have failed
reflection statements may start with…
- “it sounds like”
what should be done if ur hypothesis is wrong and you misunderstoof the pt?
- it is an opportunity for the HCP to ask the pt to clarify or tell them more
when are summary statements used
- use throughout the process to link together and reinforce material that has already been discussed
what are benefits of summary statements (5)
- help collect info
- see if anything is left out
- link info together
- get convo back on track
- reflect on content of the convo so far
what are two strategies to overcoming unintentional med nonadherence
- packaging interventions (ex. pillboxes)
- integrating med taking into existing habit and routines (ex. use behavior prompt such as phone alarm, external reminder, taking your med when brushing teeth, etc.)
what are some ways to promote med adherence (5)
- ensure the pt understands the benefits
- choose lower cost meds and ones that are easier to take
- minimize med side effects
- show the effectiveness of the meds in lower BP
- monitor med adherence
what are 2 types of motivation?
- intrinsic
- extrinsic
what is intrinsic motivation
- doing something bc it is inherently interesting or enjoyable
what is extrinsic motivation
- doing something bc it leads to a separable outcome
what predictors play a role in the theory of planned behavior (3)
- attitudes and motivation (do they agree with completing a treatment?)
- subjective norm (amt of social pressure the pt feels to proceed w treatment)
- perceived behavioral control (lvl of control the pt feels they have over the treatment or choice of treatment)
how can the theory of planned behavior be used to increase the chance that a pt will intend to proceed w treatment
- by influencing or enhancing the 3 predictors
although compliance and adherence are often used interchangably, what are the different views r/t the provider-pt relationship each have?
- compliance = authoriative undertone, implies the HCP is the authority and the pt is in a submissive role , passively following recommendeds
- adherence = degree to which follow plan of care formulated w the HCP, supports a more inclusive and active pt role , more patient-centered –> supports pt right to choose whether or not to follow treatment recommendations
describe the relationship between compliance and comittment
- pts can initially comply w a regimen, but not be committed to it
- may comply to regimen for short period of time, but may not continue to adhere for an extended period of time
non compliance can be related to… (6)
- lack of motivation or knowledge
- treatment factors like side effects
- disease issues like prognosis
- lifestyle issues: ex. transportation
- sociodemographic factors: ex. social & economic status
- psychosocial variables: depression & fear
patient factors that contribute to nonadherence include.. (6)
- stress
- forgetfulness
- substance abuse
- having multiple med conditions
- uncertainty about health beliefs and practices
- real or perceived stigma associated w the conditions of being treated
nonadherence is multifactorial, what are some factors of nonadherence (5)
- socioeconomic factors
- health care system factors
- medical condition-related disease factors
- therapy-related factors
- patient-related factors
what impact do socioeconomic factors have on nonadherence
- lower socioeconomic status associated w lower adherence
what health care system factors can improve nonadherence (2)
- post-hospital follow ups
- team-based cares
how can medical condition related disease factors impact nonadherence (2)
- concomitant conditions
- comorbidities
what therapy-related factors can impact adherence (3)
- side effects
- number and different types of pills to be taken
- complexities or changes to regimen
what patient-related factors can impact adherence (3)
- understanding of disease, its course, and possible complications
- expectations of improvement on meds
- perceptions of symptoms –> either improving or worsening
