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AC1 Kim > Week 7- Concordance > Flashcards

Week 7- Concordance Flashcards

1
Q

Define concordance

A

negotiated, shared agreement between clinician & pt concerning tx regime, outcomes & behaviours. More co-operative relationship than compliance/ non compliance

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2
Q

Define Compliance

A

Fulfilment by pt of HCPs recommended course of treatment

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3
Q

Define adherance

A

Extent to which a person’s behaviour (meds, diet, lifestyle changes) correspond with agreed recommendation from health care provider

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4
Q

How is concordance reached? (3)

A

Alliance & negotiation between prescribe & patient

Patient encouraged to discuss concerns about meds & their preferences- treatments & decision making

HCP gives evidence based information

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5
Q

What are the 2 main problems of poor concordance?

A

Treatment outcomes & direct clincal consequences

Increases financial burden on society

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6
Q

What are the factors affecting concordance? (5)

A
  • Patient centred
  • Therapy related
  • Social & economic
  • Healthcare system
  • Disease
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7
Q

What are the catagories in patient centred?

A

Demographic

Psychological

Patient Prescriber Relationship

Health Literacy

Patient Knowledge

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8
Q

In patient centered- demographic how does age affect concordance?

A

Better concordance w/ age until disability

Younger patient’s work commitments hamper concordance

Adolescents = poor concordance- rebellious

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9
Q

In patient centered- demographic how does ethinicity, gender & education affect concordance?

A

equivocal results

EXCEPT in adolescents with diabetes!

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10
Q

In patient centered- demographic how does marriage affect concordance?

A

Increased due to support form spouse

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11
Q

In patient centered psychological what beliefs & motivations increase concordance?

A

Patient believes illness poses threat

Motivated to take treatment if believe its effective

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12
Q

In patient centered psychological what beliefs & motivations decrease concordance?

A

Disease uncontrollable

Fear dependence on tx

Tx will become ineffective

Religious beliefs

Cultural

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13
Q

In patient centered psychological what negative attiudes towards theraphy decrease concordance?

A

Depression, anxiety, anger towards illness

Adolescents feel stigmatised and different to their peers

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14
Q

What affects the patient prescriber relationship?

(Patient centered sub-section)

A

Communication

Patient’s trust in prescriber

Empathy of prescriber towards patient

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15
Q

Why does the patient prescirber relationship deteriorate? (Patient centered sub-section)

A

If patients feel that Doctors lack compassion for their problems

Multiple physicians involved in care

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16
Q

How can the patient-prescriber relationship be improved?

(Patient centered sub-section)

A

Patients help design treatment plan

Detailed explanation re disease and treatment

Patients need to understand illness and therapy

17
Q

Descirbe the 4 points of health literacy

(Patient centered sub-section)

A

Being able to read

Understanding what is read

Remembering what is read

Acting on information

18
Q

In patient centered knowledge what is it importnant to have knowledge about?

A

Therapy and its role

Lifestyle changes

Clinics and their role

Long term complications

19
Q

What are the 5 factors affecting concordance?

A

Patient centred

Therapy related

Social and economic

Healthcare system

Disease

20
Q

Therpy related concordance: What should you consider?

A

Route of Administration…oral best

Treatment complexity…dosing frequency not quantity

SE

Degree of behaviour change needed

Treatment duration

21
Q

What social and economic factors affect concordance?

A

Time commitments for appointments

Unable to afford meds

Social support

22
Q

What healthcare systems affect concordance?

A

Availability & accessibility

Waiting times

Problems getting Rx

Consultation quality

23
Q

In relation to disease type, when does concordance

a) reduce?
b) improve?

A

a) Reduces with:

Fluctuating/ absent symptoms…..hypertension

Severity….adolescents better with mild asthma

b) Increases with:

Marked improvement of symptoms

Perceived poor health status

24
Q

What does the nation service framework consider?

A
25
Q

What are the challenges for the health service with concordance (3)?

A
  • Multiple tx required
  • Promote self management
  • Depression is prevelant
26
Q

Define the age range of adolesence

What is higher during adolesence?

A

10-19yrs

Higher morbidity and mortality

27
Q

What does the life-course framework for adolescent health consider?

A
  • 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
28
Q

Long term self management is initiated during adolescence

Is this life long?

What is a problem that occurs and why is this?

A

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

29
Q

Why do young people find self management and concordance challenging?

A
30
Q

What factors affect the degree to which young people manage their condition in line with clinical advice?

A
  • Age
  • Gender
  • Family context
  • SE position
  • Some barriers are similar across conditions
  • Some barriers are condition or treatment specific
31
Q

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

a) control deteriorates
b) increases with age
c) slightly higher in females
d) poorer than in other high income countries

32
Q

Why do young people find self management difficult?

A

Self monitoring: inconvenient & disruptive

Controlled by: school, parents, clinicians

Regime difficult & demanding

Difficult to fit in

Use normalisation strategies & social relationships are key factors

33
Q

What does gender refer to?

A

Social and cultural meanings assigned to being male or female

34
Q

How does gender management in DM differ between girls and boys?

A

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

AC1 Kim (29 decks)

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