Week 7: Concordance/ Adolescent self management Flashcards
Define concordance
A negotiated, shared agreement between clinician and patient concerning treatment regime (s), outcomes and behaviours; a more cooperative relationship than those based on issues of compliance and non compliance.
Define compliance
The fufilment by the patient of the healthcare professional’s recommended course of treatment.
Define adherence
The extent to which a person’s behaviour - taking medication, following a diet, and or executing lifestyle changes corresponds with agreed recommendations from a health care provider.
How is concordance reached?
- Concordance is reached through a therapeutic alliance and negotiation between the prescriber and patient.
- The patient is encouraged to dicuss concernsa bout medications that have been prescribed and preference for tx, and participation in decision making
- the health professional gives evidence based information to the patient and shares his or her clinical experience.
Give examples of therapeutic behaviours to be negotiated
- seeking medical attention
- taking medication app.
- filling prescriptions
- obtaining immunizations
- attending follow up appt.
- behavioural modification of personal hygiene
- self management of asthma or diabetes
- smoking
- contraception
- risky sexual behaviours
- unhealthy diet
- insufficient level of physical activity
What are the main effects of poor concordance?
- Problems for treatment outcomes and direct clinical consequences
- increases financial burden on society
How can poor concordance affect treatment outcomes?
- poor concordance is directly associated with poor treatment outcomes in patients with diabetes, epilepsy, AIDS, asthma, tuberculosis, hypertension, and organ transplants
- Poor concordance has an effect on long term conditions –> e.g. diabetes has many potential long term complications, it is vital concordance is embraced
describe the financial burden caused by poor concordance?
- excess urgent care visits, hospitilisation and higher tx costs
- poor concordance linked to 33-69% medication related hospital admissions in US and 25% hosp admissions in australia
- Annual burden to U.S. = 100 billion
- Annual burder to U.K of unplanned pregnancies = 135.5 million
What are the factors affecting concordance?
- Patient centred
- Therapy related
- Social and economic
- healthcare system
- disease
Factors affecting concordance:
Patient centred aspects?
- Demographic (age/ income etc)
- psychological
- patient prescriber relationship
- health literacy (degree to which individuals have capacity to retain, process and understand medical advice).
- patient knowledge
How does demographics influence concordance?
- Age –>
- better concordance as pts get older until disabilities occur
- younger patients work commitments hamper concordance
- adolescents have poor concordance –> rebellious behaviour and disagreement w parents/ authorities
- Ethnicity, Gender and education –>
- Equivocal results
- except in adolescents with diabetes
- Marriage –>
- increases concordance (may be due to support from the spouse)
How can the psychological state of the pt affect concordance?
-
Psychological state of pt affects both:
-
patient attitude towards therapy
- negative attitude towards therapy –> depression, anxiety, anger towards illness.
- adolescents feel stigmatised and different to their peers.
-
patient beliefs and motivation
- ideally patient is motivated to take the treatment if they believe it to be effective and patient believes illness poses threat
- other end of spectrum; pt believes disease uncontrollable, fear dependence on treatment and fear tx will become ineffective.
- may be religious beliefs and cultural beliefs –> e.g. malaysians fearing western medicine, supernatural beliefs in pakistan, tongans think illness is God’s will.
-
patient attitude towards therapy
What aspects affect the patient prescriber relationship?
What aspects can go wrong?
How can we improve pt prescriber relationship?
- Communication
- Patient’s trust in prescriber
- Empathy of prescriber towards patient
What goes wrong –> pts feel drs lack compassion for their problems, and multiple physicians involved in care
Improving care –> patients help design treatment plan, detailed explanation re disease and treatment, pts need to understand illness and therapy.
What aspects of health literacy are there?
- being able to read
- understanding what is read
- remembering what is read
- acting on information
How does knowledge affect concordance?
patients need knowledge of:
therapy and its role
lifestyle changes
clinics and their role
long term complications
However in adolescent compliance more knowledge is not always best –> there is an optimal level of knowledge.