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Questions and Answers
Promoting patient trust and satisfaction with care makes adherence more likely.
True
Patient autonomy means that patients have no responsibilities regarding their treatment choices.
False
Discussing treatment options and the consequences of no treatment is not important for patient decision-making.
False
Ascertaining a patient’s preferred role in decision-making can aid in achieving concordance in prescribing.
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Deferment in decision-making can be a strategy to allow patients more time to consider their options.
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Equipoise implies that there is a clear best treatment option for every patient.
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Barriers to adherence can include patient beliefs about illness and treatment.
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Communication between doctor and patient is irrelevant to treatment adherence.
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Social context can affect a patient's experience with treatment and adherence.
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Side effects of treatments have no effect on patient adherence to prescribed medication.
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Study Notes
Compliance, Adherence, & Concordance
- Compliance refers to the extent a patient follows medical advice, emphasizing a doctor-centered approach with passive patient roles.
- Adherence focuses on the alignment of patient behavior with medical recommendations, promoting patient-centered care and shared decision-making.
Extent of Non-Adherence
- Non-adherence is common; estimates show 30-50% in chronic illness cases and 10-25% of hospital admissions due to it.
- Average non-adherence rate found in a review of 733 studies is 24.8%.
- Lifestyle changes have particularly low adherence rates.
Non-Adherence Across Disease Types
- High non-adherence rates found even in serious conditions, such as renal transplant patients, with 22% non-adhering to immunosuppressants.
- Severe consequences of non-adherence: 91% of non-adherent transplant patients faced organ rejection compared to 18% of adherent patients.
- Highest adherence seen in HIV, arthritis, GI disorders, and cancer; lowest in pulmonary diseases, diabetes, and sleep disorders.
Impact of Non-Adherence
- Non-adherence negatively affects patient health and incurs financial costs.
- Enhancing adherence interventions may improve health outcomes more effectively than advancements in medical treatments.
Measurement Challenges
- Adherence is not binary; varies over time and is hard to measure consistently.
- Common measurement methods keep varying, creating discrepancies in understanding adherence rates.
Indirect Measures of Adherence
- Patient self-reports provide easy and affordable data but often lack accuracy; over-reporting noted (reported 78% vs. actual 46% adherence).
- Second-hand reports from healthcare professionals show weak correlations with actual adherence.
Objective Measures
- Pill counts are more reliable but can still be inaccurate (e.g., lost pills) and can’t provide a complete picture.
- Mechanical or electronic dosing measures offer some insight but don’t account for social and psychological factors that affect adherence.
Social Factors Influencing Adherence
- Social support is crucial; patients lacking support or experiencing isolation are less likely to adhere.
- Cohesive family environments significantly enhance the likelihood of adherence.
Psychological Factors and Adherence
- No significant correlation between demographics (e.g., age, sex, education) and adherence.
- Psychological issues like depression dramatically decrease adherence rates (depressed patients are three times less likely to comply).
Treatment Characteristics Affecting Adherence
- Preparation for treatment, such as convenience and reputation, affects adherence.
- Complex treatment regimens and administrative inadequacies can deter adherence.
Doctor-Patient Interactions
- Warm and caring physician demeanor boosts patient adherence.
- Effective communication and interpersonal competence correlate positively with adherence.
Patients’ Beliefs: Health Belief Model
- Adherence is influenced by patients’ perceptions of disease severity, susceptibility, and treatment benefits versus barriers.
- Beliefs about the necessity and side effects of medications play a critical role in adherence.
Towards Concordance in Prescribing
- Involves clearly defining the health issue with patient input and presenting treatment options.
- Encourages shared decision-making by understanding patient expectations and concerns.
- Balances evidence-based medicine with respect for patient autonomy and responsibilities.
Summary of Factors Affecting Adherence
- Key factors influencing adherence include memory, understanding, beliefs about illness and treatment, communication, and social context.
- Factors such as medication side effects, treatment complexity, and social support also play vital roles in promoting or hindering adherence.
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Description
Explore the concepts of compliance, adherence, and concordance in health psychology. This quiz will test your understanding of patient-doctor dynamics and the importance of patient adherence to medical advice. Engage with the material to deepen your knowledge of human diversity in health contexts.
