Week 7- Concordance Flashcards
Define concordance
negotiated, shared agreement between clinician & pt concerning tx regime, outcomes & behaviours. More co-operative relationship than compliance/ non compliance
Define Compliance
Fulfilment by pt of HCPs recommended course of treatment
Define adherance
Extent to which a person’s behaviour (meds, diet, lifestyle changes) correspond with agreed recommendation from health care provider
How is concordance reached? (3)
Alliance & negotiation between prescribe & patient
Patient encouraged to discuss concerns about meds & their preferences- treatments & decision making
HCP gives evidence based information
What are the 2 main problems of poor concordance?
Treatment outcomes & direct clincal consequences
Increases financial burden on society
What are the factors affecting concordance? (5)
- Patient centred
- Therapy related
- Social & economic
- Healthcare system
- Disease
What are the catagories in patient centred?
Demographic
Psychological
Patient Prescriber Relationship
Health Literacy
Patient Knowledge
In patient centered- demographic how does age affect concordance?
Better concordance w/ age until disability
Younger patient’s work commitments hamper concordance
Adolescents = poor concordance- rebellious
In patient centered- demographic how does ethinicity, gender & education affect concordance?
equivocal results
EXCEPT in adolescents with diabetes!
In patient centered- demographic how does marriage affect concordance?
Increased due to support form spouse
In patient centered psychological what beliefs & motivations increase concordance?
Patient believes illness poses threat
Motivated to take treatment if believe its effective
In patient centered psychological what beliefs & motivations decrease concordance?
Disease uncontrollable
Fear dependence on tx
Tx will become ineffective
Religious beliefs
Cultural
In patient centered psychological what negative attiudes towards theraphy decrease concordance?
Depression, anxiety, anger towards illness
Adolescents feel stigmatised and different to their peers
What affects the patient prescriber relationship?
(Patient centered sub-section)
Communication
Patient’s trust in prescriber
Empathy of prescriber towards patient
Why does the patient prescirber relationship deteriorate? (Patient centered sub-section)
If patients feel that Doctors lack compassion for their problems
Multiple physicians involved in care
How can the patient-prescriber relationship be improved?
(Patient centered sub-section)
Patients help design treatment plan
Detailed explanation re disease and treatment
Patients need to understand illness and therapy
Descirbe the 4 points of health literacy
(Patient centered sub-section)
Being able to read
Understanding what is read
Remembering what is read
Acting on information
In patient centered knowledge what is it importnant to have knowledge about?
Therapy and its role
Lifestyle changes
Clinics and their role
Long term complications
What are the 5 factors affecting concordance?
Patient centred
Therapy related
Social and economic
Healthcare system
Disease
Therpy related concordance: What should you consider?
Route of Administration…oral best
Treatment complexity…dosing frequency not quantity
SE
Degree of behaviour change needed
Treatment duration
What social and economic factors affect concordance?
Time commitments for appointments
Unable to afford meds
Social support
What healthcare systems affect concordance?
Availability & accessibility
Waiting times
Problems getting Rx
Consultation quality
In relation to disease type, when does concordance
a) reduce?
b) improve?
a) Reduces with:
Fluctuating/ absent symptoms…..hypertension
Severity….adolescents better with mild asthma
b) Increases with:
Marked improvement of symptoms
Perceived poor health status
What does the nation service framework consider?
What are the challenges for the health service with concordance (3)?
- Multiple tx required
- Promote self management
- Depression is prevelant
Define the age range of adolesence
What is higher during adolesence?
10-19yrs
Higher morbidity and mortality
What does the life-course framework for adolescent health consider?
-
Biological basis
- Observed behaviours
-
Risk behaviours
- potentially expose people to harm or significant risk of harm which are assoicated with poor health/ psychosocial outcomes
-
Risk taking is normal
- disparity in maturation between limbic and PFC
- maturation age 25yrs
- Developmentally appropriate exploratory behaviour
-
Resource & Vulnerabilities
- Biological- genes, epigenetic…
- Environment- national/local policies, community, school/workplace, peers, neighbours, family
Long term self management is initiated during adolescence
Is this life long?
What is a problem that occurs and why is this?
SM behaviours initiatives at this time remain for life
Lack of concordance is notably a problem- part of learning to SM and ftr in rather than deliberately destructive behaviour
Why do young people find self management and concordance challenging?
What factors affect the degree to which young people manage their condition in line with clinical advice?
- Age
- Gender
- Family context
- SE position
- Some barriers are similar across conditions
- Some barriers are condition or treatment specific
What happens to DM control in adolescence
How does HbA1C change with age
What gender is HbA1C higher in?
How does our DM control compare with other countires?
a) control deteriorates
b) increases with age
c) slightly higher in females
d) poorer than in other high income countries
Why do young people find self management difficult?
Self monitoring: inconvenient & disruptive
Controlled by: school, parents, clinicians
Regime difficult & demanding
Difficult to fit in
Use normalisation strategies & social relationships are key factors
What does gender refer to?
Social and cultural meanings assigned to being male or female
How does gender management in DM differ between girls and boys?
Girls:
- More likely to incorporate into identity- open w/ friends
- Self care associated w/ less parental monitoring
- ↑ frequency in ‘secret non-adherence’
- Feelings of fuily & self blame
- Pressure of self care
Boys:
- Threat to gender identity
- Less open about condition/ managed condition in public
- Less independent- mum more involved
