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Flashcards in HPsyHD S3 (needs small group LOs) Deck (22)
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1
Q

Define Compliance

A

The extent to which the patient complies with medical advice

2
Q

Define Adherence:

A

The extent to which the patient behaviour coincides with medical advice

3
Q

What is the semantic difference between compliance and adherence

A

Compliance is based on the doctor knowing best, patient must obey

Adherence is an attempt to be more patient centred, implies a need for agreement and the patient’s right to choose

4
Q

What are some severe consequences of non-adherence?

A

Transplant patients:

91% of non-adherent experience rejection

This compared to 18% of adherent

5
Q

Give examples of some conditions where adherence is particularly good or bad

A

Good:

HIV

Arthritis

GI disorders

Cancer

Bad:

Pulmonary disease

Diabetes

Sleep disorders

6
Q

What are the two major impacts of non-adherence?

A

Impact on patient’s health

Financial implications

7
Q

What are the direct measures of adherence?

Give advantages and disadvantages of each

A

Urine or blood test:

Provides most direct measure of consumption/adherence

Expensive, limited to use in clinical practice, affected by metabolism, non-adherence may be masked (taking medication before attending surgery)

Observation of consumption:

Same issues as above

8
Q

What are the indirect measures of adherence?

Give advantages and diadvantages of each

A

Pill counts:

More objective than self report

Still subject to innaccuracy (intentional masking/lost pills etc)

Mechniscal or electronic measure of dose:

E.g. Container that records when opened

Objectively measures dose dispensing

Doesn’t measure whether medication actually taken

Self-report:

Easy, inexpensive

Prone to innaccurcy and bias (non-adherence normally 10-20% higher than reported)

Second hand reports (E.g. from carers):

Same issues as self reports

9
Q

What are the factors that may contribute to non-adherence?

A

Illness faxtors

Treatment factors

Patient factors

Psychosocial factors

Healthcare factors

10
Q

Describe 2 examples of Illness factors affecting adherence

A

Symptoms:

Adherence better when symptoms experienced

Severity:

With less serious disease (E.g. hypertension/arthritis) patients in poorer health are more likely to be adherent

With serious disease (Cancer/HIV/Heart failure etc) patients in poorer health are less likely to be adherent

11
Q

Give 4 the 4 types of treatment factors affecting adherence

For each type, what are the factors that might lower adherence?

A

Preparation:

Treatment setting, waiting time, referal timing, reputation, convenience

Immediate character:

Complexity of regimen, duration, degree of behavioural change required, convenience, expense, container design

Administration:

Supervision by health care provider, continuity of care

Consequences:

Side effects (Social or physical), stigma

12
Q

What are the 2 types of patient factors affecting adherence?

A

Understanding and recall:

Understanding of information given and their illness/treatment

Recall of information on treatment (Name, frequency, duration)

Influenced by patient knowledge, importance, number of statements etc

Beliefs:

Health belief model

Adherence relies on:

Percieved severity (symptoms, understanding)

Percieved susceptibility to disease

Benefits of treatment

Barriers to following treatment

Beliefs about medication (harmful side effects, interference with daily life, tolerance, stigma)

13
Q

What is a concequence of negative patient beliefs about a medication?

A

May become non-adherent

May seek alternatives

May modify regimen

14
Q

What are the Psychosocial factors affecting adherence?

A

Psychological health:

Cognitive deficits or psychological problems impact compliance (E.g. Depression has negative impact)

Social support:

Isolation = less likely to adhere

Practical socail support and family support associated with higher adherence

Social context:

Homelessness a predictor of non-adherence

15
Q

Healthcare factors include the setting of treatment, how does this affect adherence?

A

Wether treatment is given in primary or secondary care facilities affects adherence

Regular follow ups increase adherence

High Appeal and accessibility of provider increase adherence

Beliefs and attitudes of prescriber affect adherence

16
Q

Healthcare factors affecting adherence include the doctor patient relationship, how might a doctor increase adherence through this relationship?

A

Warm, caring and friendly manner

Eye contact, smile

Good communication

Interpersonal and technical competance (higher percieved competance associated with better adherence)

17
Q

Compare unintensional to intensional non-adherence

A

Intentional:

Arises from beliefs, attitudes and expectations that influence patient’s motivation to begin and persist treatment

Unintentional:

Capacity and resource limitations

Individual constraints (memory, dexterity)

Environmental constraints (Access to prescriptions, competing demands)

18
Q

Outline the approach, effectiveness and problems associated with reducing non-adherence

A

Approaches:

Address perceptual factors influenceing motivation

Address practical barriers (capacity and resources)

Effectiveness:

Broadly effective but small effect

Better in comprehensive interventions (combining approaches) than focusing on a single cause

Problems:

Many lack theoretical basis (no-one knows why some interventions work and others dont)

Few are truly patient centered

19
Q

What is concordance?

A

Negotiation between patient and doctoe over treatment

Respecting beliefs of patient

Patient is active and can make decisions in partnership with doctor

Does not refer to patients medicine taking behaviour but the nature of interaction between clinician and patient

20
Q

How does concordance affect adherence?

A

Concordance leads to higher adherence because:

Shared ownership over treatment decisions

Beliefs, expectations, lifestyle and priorities taken into account

Barriers to adherence can be addressed

Promotes patient trust and satisfaction with care

21
Q

Outline a procedure for a clinical interacting with a patient that would maximise concordance and therfore adherance

A

Define/clarify the problem

Convey equipoise (give no set opinions on best practice)

Describe treatments and consequences

Provide written information

Check patient understanding

Elicit patient’s ICE about treatments, condition and outcomes

Ascertain patient’s prefered role in decision making

Defer if neccessary (give patient time to consult with family)

Review decisions later

22
Q

What issues are associated with always striving for maximum concordance?

A

Treatment given may not be best practice

Tension between healthcare responsibilities and patient’s right to choose